Lupus During Pregnancy Carries Higher Maternal, Fetal Morbidity Risks

Women with systemic lupus erythematosus (SLE) had higher risks for maternal and fetal morbidity compared to those without the chronic autoimmune disorder, according to a nationwide analysis of U.S. data.

The 10-year study showed that patients with SLE had higher intrauterine growth restriction versus people without SLE (8.0% vs 2.7%) and more frequent preterm delivery (14.5% vs 7.3%), reported researchers led by Bella Mehta, MD, of Weill Cornell Medical College and Hospital for Special Surgery in New York City.

Their study looked at 40 million delivery-related hospital admissions, including over 50,000 involving women with SLE. During delivery, mothers with SLE were almost four times as likely to require a blood transfusion or develop a cerebrovascular disorder and 15 times as likely to develop acute renal failure compared with those without SLE.

Morbidity for this population remains “exceedingly high,” the researchers stated in RMD Open.

Mehta told MedPage Today that the study quantified the actual risk to pregnant women with SLE. “Maternal and fetal mortality in lupus patients has been decreasing over the past two decades or so,” she said. “Now that we know that, and we can tell patients that, we wanted to also look into maternal morbidity as well as fetal morbidity and see what happens to those two indicators.”

Mehta urged clinicians to collaborate across disciplines to care for patients with SLE who want to bear children.

“I don’t want people to look at this [study] and counsel patients against pregnancies,” Mehta said. “This is only to spark a conversation, saying these risks exist, but we need to manage these patients better and work in a multidisciplinary fashion so that we can just mitigate this.”

She said future research will look at the risk differences in patient subgroups and racial demographics, which were not assessed in the current study.

Veronica Gillispie-Bell, MD, of Ochsner Health Center in Kenner, Louisiana, told MedPage Today that generally speaking, “for every case of mortality, there’s thousands of cases of severe maternal morbidity,” which makes research on maternal and fetal morbidity particularly important.

Gillispie-Bell, who was not involved in the study, agreed with Mehta that multidisciplinary care is key for SLE patients during pregnancy and beyond.

“We tend to operate in silos in medicine, which is something that I’m advocating for us to change,” she said. “We take care in our silos, we take care of our medical condition, and we don’t think about the other ways that those medical conditions are going to affect other things.”

“As we take care of women of reproductive age, we need to be asking about pregnancy intention, so that we can make sure that whatever their medical conditions are, that they’re addressed,” Gillispie-Bell added.

Mehta and colleagues used data from the National Inpatient Sample (NIS), with weighted data representing 35 million people. They identified all delivery-related hospital admissions from 2008 to 2017, including 51,161 involving women with SLE. Compared with patients without SLE, patients with SLE were older (30.1 vs 28.2 years) and more likely to be African American (24.7% vs 15%). SLE patients also were more likely to undergo care at urban teaching hospitals (70.5% vs 56.2%) and a higher percentage received Medicare (5.3% vs 0.7%).

The study used the 21 CDC standard indicators for severe maternal morbidity, which the authors grouped into six categories. They reported that in all categories, patients with SLE had worse outcomes compared with pregnant patients who did not have SLE:

• Acute renal failure: 1.5% vs 0.1%
• Cardiovascular and peripheral vascular disorders: 1.1% vs 0.1%
• Blood transfusion: 4% vs 1.1%
• Puerperal cerebrovascular disorders: 4.8% vs 1.1%
• Eclampsia or disseminated intravascular coagulation: 1.2% vs 0.4%
• General medical issues: 1.8% vs 0.5%

A study limitation was the fact that NIS uses billing information and discharge diagnosis, so some cases may have been misclassified. NIS data also do not capture outpatient deliveries, early pregnancy loss, or miscarriage.