Undiagnosed Lupus-Like Autoimmunity and unexplained stillbirth
Undiagnosed Lupus-like autoimmunity and unexplained stillbirth
University of Manchester
Women with Systemic Lupus Erythematosus(SLE) have a 20% chance of their pregnancies ending in fetal loss(miscarriage or stillbirth). 90% of people with SLE are women and 80% develop SLE in their childbearing years. The central feature of SLE is auto-antibody production. However, these women also have numerous additional pathologies detrimental to their pregnancies. A nationwide study of 1.4 million Danish women showed a clear relationship between idiopathic ‘unexplained’ stillbirth/miscarriage and subsequent onset of SLE, most notably in the first 5 years post-pregnancy loss. Given that SLE patients usually have a prolonged subclinical phase, we hypothesise that a significant number of unexplained fetal deaths can be attributed to undiagnosed SLE or lupus-like autoimmunity in affected women. To confirm this, we will recruit women with a recent stillbirth or late miscarriage, or similar women returning for subsequent antenatal visits. We will use standard serologic tests to define their lupus status, concentrating on acknowledged autoantibodies and clinical pathologies which impact their pregnancies, i.e. abnormal regulatory-T lymphocytes, inadequate hormone levels (estradiol), excessive circulating microparticles and/or elevated maternal vascular stiffness. If successful, these results could advocate nationwide antenatal screening, stratifying those at risk and implementing existing obstetric protocols to prevent impending fetal loss.
To summarise: pregnant women with the auto-immune disease Systemic Lupus Erythematosus (SLE) are more at risk of miscarriage or stillbirth. For some women these pregnancy losses occur before their SLE has been diagnosed. This research will define the numbers of women this applies to, and also what’s going wrong in their pregnancy which causes them to lose their babies. If this is known, some of these babies may be saved by providing more appropriate pregnancy care and medicines which may prevent their pregnancy loss.
North West - Greater Manchester West Research Ethics Committee
Date of REC Opinion
8 Aug 2014