Objectives Up to a quarter of pregnant individuals with SLE have small for gestational age (SGA) infants. We aimed to characterize placental pathology associated with SGA infants in SLE. Methods We retrospectively analysed SLE deliveries with placental analysis at UCSD from November 2018 to October 2023, comparing SLE pregnancies resulting in SGA to those that did not, and additionally, to matched pregnancies with SGA but without SLE. Results Placental analysis was available only for 28/70 (40%) SLE deliveries, which had high rates of adverse outcomes (75%). All exhibited at least one histopathologic abnormality. Key findings distinguishing 12 SLE placentas resulting in SGA infants (vs.16 without) included small placental disc for gestational age (100% vs 56%, P = 0.01), placental disc infarct (50% vs 6%, P = 0.02) and increased perivillous fibrin deposition (PVFD, 58% vs 0%, P = 0.001). All seven SLE placentas with increased PVFD resulted in SGA infants. Compared with matched non-SLE pregnancies with SGA (n = 36), the only distinguishing placental lesion was a higher prevalence of increased PVFD in SLE-associated SGA (58% vs 22%, P = 0.03). Conclusion The higher prevalence of increased PVFD in placentas of SLE-associated SGA may indicate a specific mechanism of placental injury leading to SGA in this context. Thus, its presence, particularly in context of SGA, should prompt providers to screen for an underlying autoimmune disease, including SLE. Systematic placental examination in context of SLE and associated autoimmune diseases could help evaluate responses to existing therapies, comparative studies of novel therapies and correlation to adverse outcomes.

中文翻译：

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系统性红斑狼疮妊娠中与小于胎龄儿相关的胎盘病变


目的 多达四分之一的 SLE 孕妇患有小于胎龄儿 （SGA）。我们旨在表征 SLE 中与 SGA 婴儿相关的胎盘病变。方法 我们回顾性分析了 2018 年 11 月至 2023 年 10 月在 UCSD 进行的 SLE 分娩和胎盘分析，比较了导致 SGA 的 SLE 妊娠与未发生 SGA 的 SLE 妊娠，此外，还比较了与 SGA 但没有 SLE 的匹配妊娠。结果 胎盘分析仅适用于 28/70 （40%） 的 SLE 分娩，其不良结局发生率高 （75%）。所有患者均表现出至少一种组织病理学异常。区分 12 例导致 SGA 婴儿的 SLE 胎盘 （vs.16 例） 的主要发现包括胎龄小胎盘 （100% vs 56%，P = 0.01）、胎盘间盘梗死 （50% vs 6%，P = 0.02） 和绒毛周围纤维蛋白沉积增加 （PVFD，58% vs 0%，P = 0.001）。所有 7 例 PVFD 升高的 SLE 胎盘都导致 SGA 婴儿。与匹配的非 SLE 妊娠 SGA （n = 36） 相比，唯一区分的胎盘病变是 SLE 相关 SGA 中 PVFD 升高的患病率更高 （58% vs 22%，P = 0.03）。结论 SLE 相关 SGA 胎盘中 PVFD 升高的患病率较高可能表明在这种情况下，胎盘损伤导致 SGA 的特定机制。因此，它的存在，尤其是在 SGA 的情况下，应促使提供者筛查潜在的自身免疫性疾病，包括 SLE。在 SLE 和相关自身免疫性疾病的情况下进行系统胎盘检查可能有助于评估对现有疗法的反应、新疗法的比较研究以及与不良结局的相关性。