Pregnancy outcome of 126 anti-SSA/Ro-positive patients during the past 24 years—a retrospective cohort study

The aims of our study are to observe the pregnancy outcome of anti-Sjögren’s syndrome-related antigen A (SSA)/Ro-positive women and to predict the risk factors for adverse pregnancy outcome and neonatal lupus erythematosus (NLE). Clinical data of 126 anti-SSA/Ro-positive patients with 140 pregnancies were evaluated retrospectively, and the newborns were followed up as a cohort in 3 months. χ ² test or logistic regression was used to predict the risk factors of lupus flares during pregnancy, fetal loss, and NLE. Twenty-six out of 93 pregnancies with systemic lupus erythematosus (SLE) experienced flares during pregnancy. Active disease prior to conception was the independent risk factor for flares [P = 0.002, odds ratio (OR) = 10.41 (95 % confidence interval (CI) = 2.34∼46.26)]. Continuous use of steroids and hydroxychloroquine (HCQ) might help decrease the risk (P = 0.041 and 0.015, respectively). Eleven out of 140 pregnancies ended with fetal loss, and 9 out of 113 live births were diagnosed with NLE. The presence of anti-phospholipid syndrome (APS) was associated with fetal loss (P = 0.018, OR = 6.41 (95 % CI = 1.57–26.14)). The presence of anti-Sjögren’s syndrome-related antigen B (SSB)/La antibodies tended to increase the risk of giving birth to an infant with NLE (P = 0.140); on the other hand, duration of disease, history of renal involvement, and active SLE during pregnancy did not contribute to the incidence of NLE (P = 0.649, 0.685, and 1.000, respectively). Active disease without regular follow-up before conception significantly increased the risk of lupus flares during pregnancy. The continuous use of low-dose steroids and hydroxychloroquine might help maintain lower SLE activity. Concurrent APS instead of high titer of anti-SSA/Ro might raise the risk of fetal loss in anti-SSA/Ro-positive patients.