Article Text

Download PDFPDF

Prediction of fetal loss in Chinese pregnant patients with systemic lupus erythematosus: a retrospective cohort study
  1. Jiayue Wu1,2,3,
  2. Wei-Hong Zhang3,4,
  3. Jinghang Ma1,2,
  4. Chunde Bao5,6,
  5. Jinlin Liu7,
  6. Wen Di1,2
  1. 1 Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  2. 2 Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
  3. 3 International Centre for Reproductive Health (ICRH), Ghent University, Gent, Belgium
  4. 4 Research Laboratory for Human Reproduction, Université Libre de Bruxelles (ULB), Brussels, Belgium
  5. 5 Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  6. 6 Shanghai Institute of Rheumatology, Shanghai, China
  7. 7 School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
  1. Correspondence to Dr Wei-Hong Zhang; weihong.zhang{at} and Dr Wen Di; diwen163{at}


Objective To develop a predictive model for fetal loss in women with systemic lupus erythematosus (SLE).

Design A retrospective cohort study.

Setting Data were collected in a tertiary medical centre, located in Shanghai, China, from September 2011 to May 2017.

Participants 338 pregnancies with SLE were analysed retrospectively. Cases of multiple pregnancy and those in which artificial abortion was performed for personal reasons were excluded.

Primary outcome measures Fetal loss was the primary outcome. A stepwise regression to identify the predictors related to the fetal loss and coefficient B of each variable was used to develop a predictive model and make a corresponding risk classification. The Hosmer-Lemeshow test, Omnibus test and area under the receiver-operating characteristic curve (AUC) were used to assess the goodness-of-fit and discrimination of the predictive model. A 10-fold cross validation was used to assess the model for overfitting.

Results Unplanned pregnancies (OR 2.84, 95% CI 1.12 to 7.22), C3 hypocomplementemia (OR 5.46, 95% CI 2.30 to 12.97) and 24 hour-urinary protein level (0.3≤protein<1.0 g/24 hours: OR 2.10, 95% CI 0.63 to 6.95; protein≥1.0 g/24 hours: OR 5.89, 95% CI 2.30 to 15.06) were selected by the stepwise regression. The Hosmer-Lemeshow test resulted in p=0.325; the Omnibus test resulted in p<0.001 and the AUC was 0.829 (95% CI 0.744 to 0.91) in the regression model. The corresponding risk score classification was divided into low risk (0–3) and high risk groups (>3), with a sensitivity of 60.5%, a specificity of 93.3%, positive likelihood ratio of 9.03 and negative likelihood ratio of 0.42.

Conclusions A predictive model for fetal loss in women with SLE was developed using the timing of conception, C3 complement and 24 hour-urinary protein level. This model may help clinicians in identifying women with high risk pregnancies, thereby carrying out monitoring or/and interventions for improving fetal outcomes.

  • systemic lupus erythematosus
  • pregnancy
  • fetal loss
  • predictive model

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Patient consent for publication Not required.

  • W-HZ and WD contributed equally.

  • Contributors JW, JM, CB, JL, W-HZ and WD were each responsible for the conception and design of the study. JW, JM and WD had full access to all of the data in the study. JW and JM collected the data. JW, JM, JL and W-HZ analysed and interpreted the data. JW drafted the initial manuscript. W-HZ., CB, JL and WD revised the manuscript. All authors read and approved the final version of the manuscript.

  • Funding The work was supported by funding from Shanghai Municipal Commission of Health and Family Planning (Grant nos. 2017ZZ02016 and 15GWZK0701).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.