Long-Term Research Shows Positive Pregnancy Outcomes in Patients With Lupus

Pregnancy in women with systemic lupous erythematosus (SLE) has long been considered high risk. However, new research presented at the 2018 American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting, in Chicago, Illinois, reported on progress over the past 20 years that has led to a decline in maternal mortality and intrauterine fetal death among patients with SLE.

A systemic inflammatory condition that can affect multiple organs, SLE can cause flares that are mild to serious. Additionally, the disease can vary between active phase and remission (quiet phase).

The retrospective analysis—a collaboration among researchers at Mount Sinai, Columbia University, and Weill Cornell, all in New York—utilized claims data from the National Inpatient Sample database gathered between 1998 and 2014. The various pregnancy-related complications identified in the 87,605 pregnant women with SLE and 70,162,163 without SLE who were hospitalized during the study period included maternal mortality, cesarean section, intrauterine fetal death, and preeclampsia/eclampsia.

“In the 1960s and 1970s, pregnancy was thought to be contraindicated in SLE patients,” Bella Mehta, MBBS, MD, a rheumatologist at the Hospital for Special Surgery in New York and the study’s coauthor, said in a statement. “Beginning in the 1980s, and especially in the 1990s, many studies identified specific risk factors for pregnancy complications and proposed best-practice management guidelines. We wished to see whether these advances improved pregnancy outcomes for SLE patients.”

The authors found that in addition to pregnant women with SLE being older than pregnant women without SLE (29.2 ±5.8 years versus 27.5 ±6.2 years), pregnant women with SLE had a greater likelihood of being African American (21% versus 12%). Additionally, and not surprisingly, pregnancies and their outcomes were much more complicated among SLE women compared to their normal counterparts:

• Cesarean section (40% vs 29%, respectively)
• Intrauterine fetal death (1.8% vs 0.65%)
• Preeclampsia or eclampsia (8.7% vs 3.5%)
• Maternal mortality per 10,000 patients (188 vs 12)
• Venous thromboembolism (0.56% vs 0.06%)
• Chronic kidney disease or glomerular disease (11.07% vs 0.08%)
• Hypertension (15.23% vs 5.01%)

Length of hospital stay was longer in the SLE population (4.1 days) compared with the non-SLE population (2.6 days), which subsequently reflected in the cost associated with the care: hospital charges were nearly double for pregnant women with SLE ($22,654 vs $12,799).

However, maternal mortality and intrauterine fetal death saw a dip over time, particularly in the SLE population (P = .002) compared to those without SLE (P = .034). Additionally, length of hospital stay reduced in SLE pregnancies (P <.001).

“Our study confirms that currently identifiable risk factors and pregnancy management practices can be used in counseling and pregnancy planning,” said Mehta about the results, adding that the higher risk of SLE pregnancies indicate that continued research remains a requirement in this patient population.

Reference

Luo Y, Xu J, Mehta BY. Pregnancy in lupus: 17-Year U.S. nationwide trend in obstetric and maternal outcomes. In: Proceedings from the American College of Rheumatology/Association of Rheumatology Health Professionals; October 19-24, 2018; Chicago, IL. Abstract 1852.