High-dose vs low-dose steroid in pregnancy patients with systemic lupus erythematosus and lupus nephritis: A systematic review and meta-analysis

Abstract

Background: Management of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in pregnancy has been improving in recent decades. However, SLE can still lead to adverse pregnancy outcomes if not appropriately treated. Optimal dose of steroids, as one of the most commonly used for the treatment of SLE and LN in pregnancy is still a subject of debate. In this review, we determine the pregnancy outcomes in SLE and LN patients treated with low vs high doses of steroids. Methods: ProQuest, Pubmed, Science Direct, Scopus, and Web of Science were carefully searched for relevant studies published in English. A total of 2,596 studies were reviewed. We extracted the data from previous studies showing the use of steroids treatment in high-dose and low-dose related to pregnancy outcomes. We provide larger data about maternal (preterm rupture of membrane, fetal loss, pre-eclampsia, and flare up) and fetal outcomes (prematurity, small gestational age, low birth weight) receiving high vs low steroid in patients with SLE and LN in this systematic review and meta-analysis. Results: A total of 13 studies were included. Of these, one study discussed a group with LN and 12 other studies discussed SLE with related maternal and fetal outcomes. Maternal outcome in the group with low-dose steroid showed a lower risk of fetal loss (odds ratio (OR): 1.93; 95% confidence interval (CI) 1.01-3.70), but there were no differences in other maternal outcomes. The low-dose steroid group showed a better fetal outcome, with a lower risk of prematurity (OR: 3.06; 95% CI 1.98-4.71), small gestational age (OR: 2.63; 95% CI 1.15-6.00), and low birth weight (OR: 2.43; 95% CI 1.23-4.79). Conclusions: In pregnant patients with SLE or LN, high-dose steroids are associated with the high risk of fetal loss during pregnancy, preterm birth, small gestational age, and low birth weight.