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PREGNANCY COMPLICATIONS HAVE REDUCED IN LUPUS PATIENTS DURING PAST TWO DECADES
CHICAGO – Over the past two decades, maternal and fetal mortality, along with important clinical outcomes, have improved in pregnancies of women with systemic lupus erythematosus (SLE), according to new research findings presented this week at the 2018 ACR/ARHP Annual Meeting (Abstract #1852).
SLE, also called lupus, is a chronic disease that causes systemic inflammation that affects multiple organs. In addition to affecting the skin and joints, lupus can affect the kidneys, the tissue lining the lungs, heart and brain. Lupus flares vary from mild to serious, and most patients have times when the disease is active followed by times when the disease is mostly quiet, which is called remission. Lupus is far more common in women than men, and requires careful management during pregnancy.
For women with SLE, pregnancy has long been considered high-risk and associated with both medical and obstetric complications. Has the outlook for pregnant women with lupus improved in recent years? 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 over the past two decades to find out.
“In the 1960s and 1970s, pregnancy was thought to be contraindicated in SLE patients,” said Bella Mehta, MBBS, MD, a rheumatologist at the Hospital for Special Surgery in New York and the study’s co-author. “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 researchers analyzed yearly retrospective trends of cross-sectional data from the National Inpatient Sample (NIS) database from 1998-2014. They identified diagnoses and procedures using ICD-9 codes. They included pregnancy-related hospital admissions with or without SLE. They also studied complications including maternal mortality, cesarean section, pre-eclampsia 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 U.S. during this 17-year time span. The SLE patients were older, and this group had a higher proportion of African-Americans, higher maternal mortality and higher intrauterine fetal death compared to those without SLE. The study also showed increased obstetric and maternal complications and comorbidities in the SLE patients compared to those without SLE.
However, the study showed a decline in maternal mortality and intrauterine fetal death over time, and this decline was greater in patients with SLE than those without lupus. Both women with SLE and those without SLE had an increase in cesarean sections, and this increase was less in the SLE patient group than the non-SLE group. The data showed that length of hospital stay decreased in SLE pregnancies over the study’s time span, but increased in non-SLE pregnancies.
“It is very encouraging to see steady improvement in maternal mortality and intrauterine fetal death, and to see that the improvements in fact outpaced improvements for non-SLE pregnancies, indicating that the new information is being adopted and is having an effect,” said Dr. Mehta. “Our study confirms that currently identifiable risk factors and pregnancy management practices can be used in counseling and pregnancy planning. Our data strongly supports wide use of the ACR Reproductive Health Guidelines that will be presented at the 2018 Annual Meeting. That SLE pregnancy risk is still higher than risk for non-SLE pregnancies indicates a need for continued research in this area.”
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About the ACR/ARHP Annual Meeting
The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, if offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official #ACR18 hashtag.
About the American College of Rheumatology
The American College of Rheumatology is an international medical society representing over 9,400 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
Abstract #: 1852
Pregnancy in Lupus: 17-Year U.S. Nationwide Trend in Obstetric and Maternal Outcomes
Yiming Luo, Mount Sinai St Luke's and Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, Jiehui Xu, Mailman School of Public Health, Columbia University Medical Center, New York, NY and Bella Y. Mehta, Hospital for Special Surgery/Weill Cornell Medicine/Mailman School of Public Health, New York, NY
Background/Purpose: Pregnancies in systemic lupus erythematosus (SLE) are considered high risk and associated with medical and obstetric complications [1]. Our objective was to study the national trends of obstetric and medical complications in pregnant SLE patients over the past 2 decades.
Methods: Our study analyzed yearly retrospective trends of cross-sectional data using National Inpatient Sample (NIS) database from 1998 to 2014. Diagnoses and procedures were identified using ICD-9 codes. We included pregnancy-related admissions (diagnosis codes 632-649, 650-669, 670-679, V27, procedure code 72-75) with and without SLE (ICD 9 code 710.0). We studied multiple medical and obstetric complications including maternal mortality, cesarean section, intrauterine fetal death, preeclampsia/eclampsia, length of stay and inflation adjusted hospital charges. Univariable logistic regression was performed to assess temporal trend in SLE and non-SLE pregnancies. Logistic regression with interaction term between SLE and year was performed to detect whether SLE was an effect modifier for our outcomes. Weights were applied to represent the nationwide estimates.
Results: 87,065 pregnant women with SLE and 70,162,163 without SLE had hospitalizations in US from 1998 to 2014. Pregnant SLE patients were older (29.2 ¡À 5.8 vs 27.5 ¡À 6.2), had a higher proportion of African Americans (21% vs 12%) and had a higher maternal mortality, and intrauterine fetal death, compared to those without SLE. (Table 1) Increased obstetric as well as maternal complications and comorbidities are observed in SLE patients compared to non-SLE patients. There was a decline in maternal mortality and intrauterine fetal death overtime and this decline was greater in SLE patients compared to those without SLE (p = 0.002 and 0.034, respectively). (Figure 1) There was an increase in cesarean section in both SLE and non-SLE pregnancies and the increase in SLE pregnancies was less than non-SLE pregnancies (p < 0.001). Length of stay decreased in SLE pregnancies however increased in non-SLE pregnancies (p < 0.001). (Table 2)
Conclusion: Maternal and fetal mortality and important clinical outcomes in SLE pregnancies have improved over the past two decades. This is the largest study of SLE pregnancies in the U.S..
[1] Peart E et al, Curr Opin Rheumatol. 2014
Disclosures: Y. Luo, None. J. Xu, None. B. Y. Mehta, None.
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