Analysis of Risk Factors for Preeclampsia in Pregnant Women with Systemic Lupus Erythematosus: A Systematic Review

Abstract

Aims: This study aims to review the literature and analyze the main risk factors contributing to the development of preeclampsia in women with Systemic Lupus Erythematosus. Methodology: The study consists of a systematic review using the PRISMA 2020 guidelines through the search for articles in the PubMed, BVC/LILACS and Cochrane databases, covering clinical trials and observational studies published between 2013 and 2023 that reporting risk factors for preeclampsia in women with Systemic Lupus Erythematosus. The articles were selected by two authors, using the Rayyan tool, and the divergences were analyzed by a third reviewer. A form previously defined by the authors was used to extract the main data from the studies and the quality of the articles was assessed using the Cochrane tool (ROBINS-I). Results: Out of the 171 articles initially selected, nine met the inclusion and exclusion criteria, encompassing a total of 500,780 women. The review identified several key risk factors for preeclampsia in women with Systemic Lupus Erythematosus, including lupus activity before and during pregnancy, younger maternal age, multiparity and high BMI. Additionally, factors such as renal disease, pregestational hypertension, mean arterial pressure (MAP) greater than 95 mmHg and previous hematological disorders were noted as significant contributors to the risk of developing preeclampsia. Lower estimated glomerular filtration rate, positive aCL-IgM, serum albumin levels below 31.5 g/L, elevated serum uric acid levels, and 24-hour proteinuria were also associated with increased risk. Furthermore, the use of prednisolone was linked to a higher risk, while antimalarial drugs were found to be protective against the development of preeclampsia. Conclusion: Certain factors associated with women with Lupus contribute to the development of preeclampsia. Early identification of these risk factors may enable targeted follow-up and timely interventions to prevent and manage potential complications.