New Study Clarifies Risks of Pregnancy for Patients with Lupus

Newswise — Women who have been diagnosed with systemic lupus erythematosus face increased risks of death, infection, clotting complications, and complications related to blood loss when they become pregnant, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Washington, DC.

Systemic lupus erythematosus (also called SLE or lupus) is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and/or other organs of the body. The most common symptoms include skin rashes and arthritis, often accompanied by fatigue and fever, typically experienced during alternating periods of remission and relapse. SLE occurs 10 times more often in women than in men. The disorder typically develops in people in their twenties and thirties -prime childbearing years. SLE is more common in certain ethnic groups, particularly in blacks and Asians, who also tend to be more severely affected.

Women who have SLE face certain additional risks and complications when they become pregnant. However, due to the relative rarity of the disease, it has been difficult up to now to get good statistics about those risks that would quantify and contextualize the complications they may face so that women and their physicians can better weigh their options.

A new study used a national database to measure the risk of maternal complications in women who have SLE. The National Inpatient Survey database contains records for a representative subset of all pregnancies resulting in hospital admissions between 2000 and 2002; the researchers examined the records of the more than 17,000 women with SLE who gave birth during that period.According to their findings, women with SLE were significantly more likely to have other medical conditions associated with adverse pregnancy outcomes, including renal failure, antiphospholipid syndrome, hypertension, and diabetes.

The risk of maternal mortality among women with SLE was twenty times higher than that of women without the disease, or 325/100,000 live births, compared to 14/100,000 in non-SLE pregnancies.

The risk for dangerous blood clots was increased. Women with lupus were also more likely to have serious infections, including sepsis (bacterial blood infections) and pneumonia. Though the risk for urinary tract infection was three times higher among lupus patients, the risk for that infection spreading to the kidneys was not increased. More women with SLE had low blood platelet counts and anemia during delivery, which may have contributed to their 3-fold increased need for transfusion during pregnancy.

"Women with lupus are at higher risk for complications, including death, during pregnancy than healthy women. However, woman with lupus are already at higher risk for these complications. Based on this study, we can not determine if these risk increase during pregnancy," said Megan Clowse, MD, Assistant Professor in the Division of Rheumatology & Immunology at Duke University Medical Center, Durham, NC, and lead investigator in the study. "We encourage all women with lupus to discuss their personal risks of pregnancy with their rheumatologist and obstetrician prior to becoming pregnant."

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.

Presentation Number: 550

National Study of Medical Complications in SLE Pregnancies

Megan E. B. Clowse, Margaret G. Jamison, Evan Myers, Andra H. James. Duke University, Durham, NC

Purpose: The ability to determine the risk of rare medical complications in pregnancies to women with Systemic Lupus Erythematosus (SLE) is limited by the size of current cohorts. We used a national database to measure the risk of maternal complications in SLE pregnancies.

Methods: The Nationwide Inpatient Survey (NIS) includes demographic and ICD9-CM data from a 20% stratified sample of all hospital discharges. We queried the NIS from 2000 through 2002 to identify all pregnancy-related admissions for women with SLE. The primary outcome was maternal mortality. Secondary outcome measures included thrombotic, infectious, and hematologic complications.The analysis accounted for the stratified sampling design used by NIS. Two-way chi-square tests using complex-survey estimation techniques generated cell frequencies and standard deviations. Logistic regression modeling produced odds ratios and confidence intervals.

Results: Out of over 18.3 million pregnancy-related admissions from 2000 through 2002, 17,262 (0.01%) were to women with SLE. Women with SLE were significantly more likely to have other medical conditions associated with adverse pregnancy outcomes, including renal failure (OR 35.8, p<0.001), antiphospholipid syndrome (APS) (OR 31.9, p<0.001), hypertension (OR 6.4, p<0.001), and diabetes (OR 1.6, p<0.001). Reported rates for obesity, smoking, and substance abuse rates were not significantly higher among women with SLE.

Women with lupus were at increased risk for pregnancy complications (see table). Maternal mortality among women with SLE was 325/100,000 live births, compared to 14/100,000 in non-SLE pregnancies (OR 20, p<0.001). The risk for thrombosis was increased. Women with lupus were also more likely to have serious infections, including sepsis and pneumonia. Though the risk for UTI was 3 times higher among lupus patients (p<0.001), the risk for pyelonephritis was not increased. More women with SLE had thrombocytopenia and anemia during delivery, which may have contributed to their 3-fold increased need for transfusion during pregnancy.

Pregnancy complication Odds Ratio 95% CI p-valueThrombotic ComplicationsStroke 2.2 1.7 to 2.8 <0.001Pulmonary Embolus 3.2 1.7 to 6.4 <0.001DVT 5.8 2.1 to 9.6 <0.001Infectious ComplicationsSepsis 3.5 2.0 to 6.0 <0.001Pneumonia 4.3 3.1 to 5.9 <0.001Hematologic ComplicationsTransfusion 3.6 2.8 to 4.2 <0.001Postpartum hemorrhage 1.2 1.0 to 1.5 0.01Antepartum bleeding 1.8 1.3 to 2.4 <0.001Anemia at delivery 1.9 1.7 to 2.2 <0.001Thrombocytopenia 8.3 6.8 to 10.1 <0.001

Conclusions: Women with SLE are at increased risk for serious medical complications during pregnancy, contributing to their 20-fold higher risk of death.

Disclosure Block: M.E. Clowse, None; M.G. Jamison, None; E. Myers, None; A.H. James, Non