Bromocriptine during pregnancy in systemic lupus erythematosus: a pilot clinical trial.

Bromocriptine (BRC) prevents postpartum flare in lupus patients. However, its potential role in protecting lupus pregnancy from maternal-fetal complications has not been studied. The objective of the study was to explore the role of oral BRC during pregnancy in patients with systemic lupus erythematosus (SLE). Pregnant SLE patients were randomized into two groups: group 1 received BRC 2.5 mg/day and prednisone 10 mg/day; group 2 received prednisone 10 mg/day. These treatments were administered from 25 to 35 weeks of gestation. Prolactin (PRL) levels were determined at 25, 30, and 35 weeks. The SLE Pregnancy Disease Activity Index, maternal-fetal outcome including preterm birth, fetal loss, premature rupture of membrane (PRM), low birth weight, and preeclampsia/eclampsia were evaluated. We studied 20 patients (10 in each group). A significant decrease of PRL levels in group 1 compared to group 2 at week 30 and at week 35 was found. No patients in the BRC group had flares and three from group 2 had SLE activity. None of the patients in group 1 had PRM but three patients in group 2 did. Eighty percent of pregnancies ended in birth at term in group 1 and 50% in group 2. There was no fetal loss in both groups. Mean birth weight was higher in group 1 than in group 2 (P < NS). BRC was well tolerated. This is the first clinical trial of BRC in SLE pregnancy. Our pilot study suggests that BRC may play a role in the prevention of maternal-fetal complications, such as PRM, preterm birth, and active disease.

Prolactin levels are associated with lupus activity, lupus anticoagulant, and poor outcome in pregnancy.

High prolactin (PRL) levels seem to be associated with active systemic lupus erythematosus (SLE) during pregnancy. However, the association of activity, lupus anticoagulant (LA), and pregnancy outcome has not been analyzed. The objective of this study was to analyze the association among SLE activity, LA, and maternal-fetal outcome. We studied 15 pregnant SLE patients (ACR criteria), 4 of them with associated antiphospholipid syndrome (APS), and 9 healthy pregnant women. All patients were evaluated monthly with the following determinations: (a) SLE activity using modified-systemic lupus activity measurement (m-SLAM), (b) LA, and (c) PRL serum levels. Healthy controls were evaluated each trimester. Prematurity, fetal loss, low birth weight, and preeclampsia were evaluated. Chi-square test, Fisher's exact test, Student's t-test, Pearson correlation, and ANOVA were performed. The mean age of SLE patients was 30 +/- 4.9 years and 27.1 +/- 3.7 years in controls. High PRL levels were found during the second and third trimester in SLE patients in comparison with controls (186.2 +/- 54.02 ng/mL versus 119.6 +/- 31.1 ng/mL (P < 0.01) and 177.4 +/- 48.6 ng/mL versus 158.3 +/- 31.5 ng/mL. A significant linear correlation between PRL, m-SLAM, and LA in association with poor maternal-fetal outcome was observed. LA and PRL conferred risk for poor pregnancy outcome. Our study indicates for the first time a strong association among PRL, LA, SLE activity, and poor pregnancy outcome. Close rheumatologic and obstetric monitoring is mandatory in SLE pregnancy in order to avoid obstetric complications.