Impact of pregnancy on organ damage in systemic lupus erythematosus: a multicentre study
6 affiliations
- 1Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- 2Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- 3Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
- 4Division of Rheumatology, Ospedale La Colletta-Azienda Sanitaria Locale 3, Genova, Italy
- 5Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- 6Department of Clinical and Experimental Medicine and Department of Mathematics, University of Pisa, Pisa, Italy
Abstract
Objectives Pregnancy in SLE is associated with increased maternal and fetal risks but its impact on irreversible organ damage remains unclear. We assessed whether pregnancy independently contributes to short-term organ damage accrual in women with SLE.Methods We retrospectively analysed prospectively collected data from two tertiary referral centres with dedicated pregnancy clinics. Women fulfilling SLE classification criteria were included if complete damage assessments were available from 2 years before conception to 1 year after conception. Organ damage was assessed using the Systemic Lupus International Collaborating Clinics Damage Index (SDI). Within-patient SDI changes during the pregnancy/early postpartum period were compared with the pre-pregnancy reference period. Given the limited number of events, effect sizes and CIs were prioritised. Sensitivity analyses included non-parametric effect sizes and restriction to one pregnancy per woman.Results 165 pregnancies were included. At conception, most women were in remission or low disease activity. During pregnancy, 20.6% experienced disease flares, predominantly mild to moderate. Overall, cumulative damage remained stable: mean SDI increased from 0.18±0.43 one year before conception to 0.22±0.52 one year after conception (mean ΔSDI 0.04±0.21), with a median change of zero. Only seven pregnancies (4.2%; 95% CI 2.1% to 8.5%) showed new damage, limited to a single SDI item. Pre-existing damage was associated with progression (OR 6.77; 95% CI 1.43 to 32.05), and the frequency of progression was similar when the analyses were restricted to a single pregnancy per woman (6/126, 4.8%). By contrast, disease activity at the time of conception, flare-ups, obstetric complications and treatments were inconclusive. In the sensitivity analysis, the association with pre-existing damage was confirmed, and baseline disease activity also emerged as associated with damage progression (rank-biserial r=−0.55; 95% CI −0.78 to −0.27, p=0.030).Conclusions In women with predominantly well-controlled SLE, short-term organ damage accrual during pregnancy and the early postpartum period was uncommon. Pre-existing damage was associated with further accrual, while baseline disease activity also emerged as associated in the sensitivity analysis; however, the small number of events limits conclusions regarding other potential risk factors.
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BibTeX
@article{tani2026impact,
title = {{Impact of pregnancy on organ damage in systemic lupus erythematosus: a multicentre study}},
author = {Chiara Tani and Marta Mosca and Elena Elefante and Margherita Zen and Maddalena Larosa and Dina Zucchi and Francesca Monacci and Sabrina Gori and Maria Laura Manca and Giancarlo Cascarano and Greta Hulej and Martina Benvenuti and Chiara Ietto},
journal = {Lupus Science and Medicine},
year = {2026},
month = oct,
doi = {10.1136/lupus-2026-002269},
url = {https://doi.org/10.1136/lupus-2026-002269},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of pregnancy on organ damage in systemic lupus erythematosus: a multicentre study
AU - Chiara Tani
AU - Marta Mosca
AU - Elena Elefante
AU - Margherita Zen
AU - Maddalena Larosa
AU - Dina Zucchi
AU - Francesca Monacci
AU - Sabrina Gori
AU - Maria Laura Manca
AU - Giancarlo Cascarano
AU - Greta Hulej
AU - Martina Benvenuti
AU - Chiara Ietto
PY - 2026
DA - 2026/10/24
JO - Lupus Science and Medicine
DO - 10.1136/lupus-2026-002269
UR - https://doi.org/10.1136/lupus-2026-002269
AB - Objectives Pregnancy in SLE is associated with increased maternal and fetal risks but its impact on irreversible organ damage remains unclear. We assessed whether pregnancy independently contributes to short-term organ damage accrual in women with SLE.Methods We retrospectively analysed prospectively collected data from two tertiary referral centres with dedicated pregnancy clinics. Women fulfilling SLE classification criteria were included if complete damage assessments were available from 2 years before conception to 1 year after conception. Organ damage was assessed using the Systemic Lupus International Collaborating Clinics Damage Index (SDI). Within-patient SDI changes during the pregnancy/early postpartum period were compared with the pre-pregnancy reference period. Given the limited number of events, effect sizes and CIs were prioritised. Sensitivity analyses included non-parametric effect sizes and restriction to one pregnancy per woman.Results 165 pregnancies were included. At conception, most women were in remission or low disease activity. During pregnancy, 20.6% experienced disease flares, predominantly mild to moderate. Overall, cumulative damage remained stable: mean SDI increased from 0.18±0.43 one year before conception to 0.22±0.52 one year after conception (mean ΔSDI 0.04±0.21), with a median change of zero. Only seven pregnancies (4.2%; 95% CI 2.1% to 8.5%) showed new damage, limited to a single SDI item. Pre-existing damage was associated with progression (OR 6.77; 95% CI 1.43 to 32.05), and the frequency of progression was similar when the analyses were restricted to a single pregnancy per woman (6/126, 4.8%). By contrast, disease activity at the time of conception, flare-ups, obstetric complications and treatments were inconclusive. In the sensitivity analysis, the association with pre-existing damage was confirmed, and baseline disease activity also emerged as associated with damage progression (rank-biserial r=−0.55; 95% CI −0.78 to −0.27, p=0.030).Conclusions In women with predominantly well-controlled SLE, short-term organ damage accrual during pregnancy and the early postpartum period was uncommon. Pre-existing damage was associated with further accrual, while baseline disease activity also emerged as associated in the sensitivity analysis; however, the small number of events limits conclusions regarding other potential risk factors.
SN - 2053-8790
ER -