{
  "abstract": "Objectives Giving birth to a small for gestational age (SGA) infant is a common adverse pregnancy outcome in women with SLE, but the local underlying pathogenetic mechanisms are largely unknown. We aimed to determine whether specific placental histopathological patterns of injury are associated with SGA in SLE pregnancy.Methods We prospectively followed 83 SLE and 67 healthy pregnancies and placentas were collected unselectively without clinical indication. Placental pathology reports were available from 63 SLE and 46 healthy pregnancies. SGA was defined as a birth weight less than the 10th percentile of expected. Placentas were evaluated by a placental pathologist who recorded placental weight and the presence of maternal vascular malperfusion (MVM, defined as a small placental disc and at least one of: accelerated villous maturation, placental disc infarction and decidual vasculopathy), chorioamnionitis and funisitis. Soluble FMS-like tyrosine kinase-1 (S-Flt1) and placental growth factor (PlGF) were quantified using Legendplex.Results In SLE pregnancies, placental weight was reduced compared to healthy controls, and the most common complication was giving birth to a small for gestational age (SGA) infant (SLE 17% vs. controls 3%). Placental weight was lower in SLE pregnancy resulting in SGA compared to those not, and placentas were more often small for their gestational age. Among placentas from women with SLE who gave birth to SGA infants, 80% displayed signs of MVM compared to 20% of placentas of patients who had children who were normal or large for gestational age. Chorioamnionitis and funisitis were not evident in placentas of women with SGA. Women with SLE and evidence of MVM, compared to those without, gave birth to infants with lower birth weight and shorter birth length. The ratio of S-Flt1/PlGF was higher in women with SLE who gave birth to an SGA infant compared to women who did not, and in women with placental MVM compared to no MVM.Conclusions Impaired placental perfusion and spiral artery development may contribute to SGA in women with SLE, a conclusion further supported by an altered balance of the pro- and antiangiogenic factors S-Flt1/PlGF during SLE pregnancy resulting in SGA.",
  "authors": [
    {
      "affiliations": [
        "Dept of Rheumatology and Inflammation Research, Inst of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Marit Stockfelt"
    },
    {
      "affiliations": [
        "Dept of Pathology, University of Helsinki, Helsinki, Finland"
      ],
      "name": "Henri Puttonen"
    },
    {
      "affiliations": [
        "Dept of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden"
      ],
      "name": "Ing -Marie Fyhr"
    },
    {
      "affiliations": [
        "Dept of Rheumatology and Inflammation Research, Inst of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Agnes Torell"
    },
    {
      "affiliations": [
        "Dept of Rheumatology and Inflammation Research, Inst of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Kerstin Andersson"
    },
    {
      "affiliations": [
        "Dept of Medicine Solna, Div of Rheumatology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden"
      ],
      "name": "Iva Gunnarsson"
    },
    {
      "affiliations": [
        "Dept of Medicine Solna, Div of Rheumatology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden"
      ],
      "name": "Elisabet Svenungsson"
    },
    {
      "affiliations": [
        "Dept of Medicine Solna, Div of Rheumatology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden"
      ],
      "name": "Agneta Zickert"
    },
    {
      "affiliations": [
        "Dept of Womens and Childrens Health, Div for Obstetrics, Gynecology and Neonatology, Karolinska University Hospital, Stockholm, Sweden"
      ],
      "name": "Maria Majcuk Sennström"
    },
    {
      "affiliations": [
        "Dept of Rheumatology and Inflammation Research, Inst of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Estelle Trysberg"
    },
    {
      "affiliations": [
        "Dept of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden"
      ],
      "name": "Anders A Bengtsson"
    },
    {
      "affiliations": [
        "Dept of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden"
      ],
      "name": "Andreas Jönsen"
    },
    {
      "affiliations": [
        "Dept of Obstetrics and Gynecology, Inst of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden"
      ],
      "name": "Helena Strevens"
    },
    {
      "affiliations": [
        "Div of Inflammation and Infection, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden"
      ],
      "name": "Christopher Sjöwall"
    },
    {
      "affiliations": [
        "Div of Inflammation and Infection, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden"
      ],
      "name": "Muna Saleh"
    },
    {
      "affiliations": [
        "Dept of Biomedical and Clinical Sciences, Div of Childrens and Womens Health, Linköping University, Linköping, Sweden"
      ],
      "name": "Sofia Pihl"
    },
    {
      "affiliations": [
        "Dept of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden"
      ],
      "name": "Dag Leonard"
    },
    {
      "affiliations": [
        "Dept of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden"
      ],
      "name": "Lars Rönnblom"
    },
    {
      "affiliations": [
        "Dept of Womens and Childrens Health, Section of Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden"
      ],
      "name": "Tansim Akhter"
    },
    {
      "affiliations": [
        "Dept of Obstetrics and Gynecology, Inst of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Bo Jacobsson"
    },
    {
      "affiliations": [
        "Dept of Rheumatology and Inflammation Research, Inst of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Anna-Carin Lundell"
    },
    {
      "affiliations": [
        "Dept of Rheumatology and Inflammation Research, Inst of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Anna Rudin"
    }
  ],
  "title": "PT6:07 Maternal vascular malperfusion of the placenta but not chorioamnionitis is associated with small for gestational age infants in systemic lupus erythematosus",
  "uid": "49fe843f-f26b-5c5a-a7c8-5b601b213c82"
}