Fragmented QRS and P-Wave Dispersion in Pregnancies Complicated by Systemic Lupus Erythematosus

To compare electrocardiographic (ECG) parameters in pregnancies complicated by systemic lupus erythematosus (SLE) with healthy controls and to investigate whether fragmented QRS (fQRS) and atrial conduction indices are associated with composite adverse perinatal outcomes (CAPO). This retrospective case–control study included 30 pregnant women with SLE without documented clinical evidence of active disease and 95 healthy pregnant controls. All participants underwent 12-lead ECG evaluation at 36–37 weeks of gestation. fQRS presence, ventricular and atrial conduction parameters, including P-wave dispersion (PWD), were assessed. Univariate and multivariable logistic regression analyses were performed to evaluate the association between fQRS and CAPO, defined as fetal distress, neonatal intensive care unit admission, or a 5-minute Apgar score < 7. The prevalence of fQRS was significantly higher in the SLE group compared with controls (23.3% vs. 9.5%, p = 0.032). Pregnant women with SLE also demonstrated prolonged P-wave maximum duration and increased P-wave dispersion (70 ms vs. 60 ms, p = 0.003), indicating greater atrial conduction heterogeneity. fQRS remained associated with CAPO after adjustment for gestational age (adjusted OR: 3.40, 95% CI: 1.06–10.92, p = 0.040). Pregnancies complicated by SLE exhibit increased fQRS prevalence and P-wave dispersion, indicating altered maternal cardiac electrophysiological patterns during pregnancy. An association between fQRS and CAPO was also observed; however, this finding should be considered hypothesis-generating and requires confirmation in larger prospective studies.