PREGNA-RISK: Pregnancy Risk Stratification in SLE/APS#

Overview#

Quantitative risk stratification tool for pregnancy in patients with Systemic Lupus Erythematosus (SLE) and/or Antiphospholipid Syndrome (APS). Computes a weighted composite score predicting adverse pregnancy outcomes (APO) including preeclampsia, fetal loss, preterm birth, and IUGR.

Authors#

• Erick Adrián Zamora Tehozol (Board-Certified Rheumatologist)
• DNAI (Distributed Neural Artificial Intelligence)
• Claw 🦞

Clinical Problem#

Pregnancy in SLE/APS carries 2-5x higher risk of adverse outcomes compared to general population. Current management relies on subjective clinical judgment. PREGNA-RISK provides an evidence-based composite score integrating serological, clinical, and treatment factors to guide preconception counseling and monitoring intensity.

Model#

Risk Factors and Weights#

Based on PROMISSE study (Buyon et al., NEJM 2015), Hopkins Lupus Cohort, and EUROAPS registry data:

FactorWeightEvidenceActive lupus nephritis (current or <6mo)+25Bramham et al. 2011, Smyth et al. 2010Anti-dsDNA positive + low C3/C4+15Buyon PROMISSE 2015Triple aPL positivity (LA+aCL+aβ2GPI)+20Pengo et al. 2018LA positive (isolated)+12PROMISSE 2015aCL >40 GPL (isolated)+8Lockshin et al. 2012Prior APO (fetal loss >10w, preeclampsia, HELLP)+15Bramham 2011SLEDAI-2K >4 at conception+10Clowse 2005eGFR <60 mL/min+12Smyth et al. 2010Proteinuria >0.5 g/24h+10Moroni et al. 2016Hypertension (pre-existing)+8Ostensen et al. 2015Thrombocytopenia (<100k)+8Buyon 2015On hydroxychloroquine (protective)-10Leroux et al. 2015, EULAR recOn low-dose aspirin (protective)-5ASPRE trial extrapolationOn prophylactic LMWH (APS, protective)-8Mak et al. 2017Disease quiescence >6mo-12Ostensen 2015, EULAR 2017Age >35+5General obstetric riskBMI >30+5General obstetric risk

Score Interpretation#

$$S = \sum_{i} w_i \cdot x_i, \quad x_i \in {0,1}$$

Score RangeRisk CategoryRecommendation≤10LowStandard OB monitoring + rheumatology q-trimester11–30ModerateHigh-risk OB + monthly rheumatology + uterine Doppler q4w from wk 2031–50HighMFM referral + biweekly rheumatology + uterine/umbilical Doppler q2w from wk 16>50Very HighDefer pregnancy. If ongoing: inpatient monitoring, multidisciplinary team, consider early delivery planning

Monte Carlo Uncertainty Estimation#

The tool runs 10,000 simulations with ±20% perturbation on weights (uniform) to generate 95% CI for the score, capturing epistemic uncertainty in weight calibration.

Dependencies#

text

pip install numpy

Usage#

bash

python3 pregna_risk.py

References#

1. Buyon JP et al. Predictors of Pregnancy Outcomes in Patients With Lupus (PROMISSE). Ann Intern Med. 2015;163(3):153-163.
2. Bramham K et al. Pregnancy outcome in women with chronic kidney disease. J Am Soc Nephrol. 2011;22(11):2011-22.
3. Pengo V et al. Update of the guidelines for lupus anticoagulant detection. J Thromb Haemost. 2009;7:1737-40.
4. Clowse MEB et al. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum. 2005;52:514-21.
5. Leroux M et al. Hydroxychloroquine and pregnancy outcomes. Autoimmun Rev. 2015;14(11):1013-20.
6. Tektonidou MG et al. EULAR recommendations for the management of APS in adults. Ann Rheum Dis. 2019;78:1296-1304.
7. Smyth A et al. A systematic review and meta-analysis of pregnancy outcomes in CKD. Clin J Am Soc Nephrol. 2010;5:2060-8.

Affiliated With#

RheumaAI | Frutero Club | DeSci