Table 2.
Pregnancy characteristics and outcome in belimumab group.
| Case | Age (y) at pregnancy | Characteristics of pregnancy | BEL exposure of the neonate | Concomitant treatment during pregnancy | SLEDAI | Maternal outcome | Foetal outcome |
|---|---|---|---|---|---|---|---|
| 1 | 38 | Disease in remission 2 years Spontaneous planned pregnancy | Conception to 33rd w of gestation | HCQ 400 mg, LDA 150 mg, vitamin D | At conception: 0 At delivery: 0 3 m after delivery: 0 | Lupus in remission. No incidents BEL restart at delivery | Alive, term (38 + 3w) twins, caesarean section due to breech foetal position of 2nd foetus; 3030 g, Apgar 9-10; 2680 g. Apgar 5-9-10 |
| 2, 1st pregnancy | 34 | Disease in remission 6 m Spontaneous non-planned pregnancy | Conception to 4th w of gestation | PD 7.5 mg, HCQ 300 mg, AZA 50 mg, LDA 100 mg, vitamin D | At conception: 2 At delivery: 2 3 m after delivery: 2 | Lupus in remission. PPROM BEL restart 16 m after delivery due to LES flare | Alive, preterm (35 + 5), vaginal delivery, LBW (2220 g) Apgar 10-10 |
| 2, 2nd pregnancy | 37 | Disease in remission 3 years Spontaneous planned pregnancy | Conception to 12th w of gestation | PD 5 mg, HCQ 200 mg, LDA 100, vitamin D | At conception: 1 3 m after pregnancy interruption: 1 | Lupus in remission BEL continued | Trisomy 18 detected at 12 w, elective termination |
| 3, 1st pregnancy | 31 | Disease in remission 4 years Spontaneous planned pregnancy | Conception to miscarriage | HCQ 300 mg, LMWH, vitamin D | At conception: 2 3 m after pregnancy loss: 2 | Lupus in remission, only positive dsDNA. No incidents BEL continued | Spontaneous miscarriage at 7 w |
| 3, 2nd pregnancy | 32 | Disease in remission 5 years Spontaneous planned pregnancy | Conception to 35 + 5w of gestation | HCQ 300 mg, LMWH, vitamin D | At conception: 0 At delivery: 4 3 m after delivery: 6 | Lupus in remission, only positive dsDNA. No incidents. BEL restart at delivery | Alive, term (39 + 4w), caesarean section for non-progression; 3890 g, Apgar 8-9 |
| 4 | 37 | Disease in low activity 3 years Spontaneous non-planned pregnancy | Weekly: Conception to 12th w of gestation Every two w: 13th to 35th of gestation | HCQ 400 mg, AZA 150 mg, LDA 100 mg, vitamin D | At conception: 4 At delivery: 2 3 m after delivery: 4 | Lupus in low activity. No incidents She decided not to restart belimumab at delivery but did it 3 m later due to lupus flare |
Alive, term (39 w) vaginal delivery, 3240 g Apgar 10-10 |
| 5 | 40 | Disease in remission 4 years Programmed pregnancy, obtained through ART | None (the last belimumab, 15 m prior to pregnancy) | LDA 100 mg, HCQ 200 mg, AZA 50 mg, LMWH | At conception: 2 At delivery: 10 3 m after delivery: 8 | W 28: Mild flare (arthralgias, lymphopenia, low complements, increase in dsDNA) requiring PD 5 mg and HCQ 300 mg Moderate flare at delivery, BEL restart 3 w after delivery with PD 15 mg/day | Alive, term (38 + 4w) induction due to foetal growth arrest. Vaginal delivery, 2680 g. Apgar 10-10 |
| 6 | 33 | Disease in remission 3 years Spontaneous planned pregnancy | Weekly: Conception to 16th w of gestation Every two w: 17th to 36th w of gestation | LDA 100 mg, PD 2.5 mg, HCQ 200 mg, vitamin D | At conception: 0 At delivery: 0 3 m after delivery: 0 | Lupus in remission. No incidents Seroma in caesarean scar, topical treatment; BEL restarted 6 w after delivery | Alive, term (38 w) induction due to IUGR type I; caesarean section due to LFW, LBW (2360 g). Apgar 9-10 |
AZA, azathioprine; BEL, belimumab; HCQ = hydroxychloroquine; CTG, cardiotocography; GN, glomerulonephritis; HA, haemolytic anaemia; IVIg, intravenous immunoglobulin therapy; IUGR, Intrauterine growth restriction; LBW, low birth weight; LDA, low dose aspirin; LFW, loss of foetal wellbeing; LMWH, low molecular weight heparin; LN, lupus nephritis; M: months; MPA, mycophenolic acid; MCTD, mixed connective tissue disease; MTX, methotrexate; OA, oral anticoagulants; PD, prednisone; W: weeks; Y: years.