Systemic lupus erythematosus (SLE) is a chronic disease that causes systemic inflammation and affects multiple organs. The condition is far more common in women than in men, and pregnancy in women with lupus has long been considered a high risk for medical and obstetric complications.
However, research presented at the annual meeting indicates that maternal and fetal mortality, as well as outcomes, have improved among pregnant women with lupus over the past two decades.
“In the 1960s and 1970s, pregnancy was thought to be contraindicated in [patients with] SLE,” said Bella Mehta, MBBS, MD, of the Hospital for Special Surgery in New York. “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 [patients with] SLE.”
Therefore, researchers at academic medical centers around New York City conducted a study of national trends in medical and obstetric complications in pregnant women with SLE. They analyzed yearly retrospective trends of cross-sectional data from the National Inpatient Sample database from 1998 to 2014. They included pregnancy-related hospital admissions with or without SLE. They also studied complications, including maternal mortality, Cesarean section, preeclampsia or eclampsia, length of stay, and inflation-adjusted hospital charges.
The study included 87,065 pregnant women with SLE and 70,162,163 pregnant women without SLE who had been hospitalized in the United States during the 17-year period. Patients with SLE were older and had a higher proportion of African-Americans, higher maternal mortality, and higher intrauterine fetal death compared with those without SLE. The study also showed increased obstetric and maternal complications and comorbidities in the SLE population.
But the study also found a decline in maternal mortality and intrauterine fetal death over time—and the decline was greater in patients with SLE than those without lupus. In addition, hospital length of stay decreased in SLE pregnancies but increased in non-SLE pregnancies.
The researchers concluded that new information about pregnancy in lupus is being adopted and is having an effect, and they referred rheumatologists and obstetricians/gynecologists to the American College of Rheumatology’s soon-to-be-released reproductive health guidelines.