Risk of Pregnancy Complications Greater in Women with Systemic Lupus Erythematosus

Bella Mehta, MBBS, MS

New data from a retrospective review of the National Inpatient Sample (NIS) is underlining the importance of a multidisciplinary care team in optimizing care for women with systemic lupus erythematosus (SLE) who become pregnant.

With data from more than 8 million delivery-related hospital admissions, investigators detail the characteristics of pregnant SLE patients compared to their pregnant counterparts without SLE and also provide insight into the increased risk of fetal morbidity, including risk of intrauterine growth restriction and preterm delivery, among this patient population.

“The number of co-existing health conditions in pregnant women with lupus was much higher compared to women who did not have lupus. It seems likely that these comorbidities are responsible – at least in part – for the increased risk of fetal and maternal morbidity in lupus patients,” said lead investigator Bella Mehta, MBBS, MS, a rheumatologist at Hospital for Special Surgery (HSS), in a statement. “It is noteworthy that a large percentage of deliveries by women with lupus were at large hospitals and urban teaching hospitals, reflecting the complexities of managing these patients.”

Despite significant advances in care, recent data indicate rates of maternal mortality and severe maternal morbidity have been on the rise in the US. With SLE the most common form of lupus and impacting women of childbearing age, Mehta and a team of colleagues from the HSS launched the current study with the intent of providing fellow clinicians with an overview of the fetal and maternal morbidity in SLE deliveries compared to non-SLE deliveries in the US over the course of a decade. To do so, investigators designed their study as a retrospective analysis of data obtained from the NIS database related to all delivery-related hospital admissions of patients with and without SLE from 2008-2017, with these patients identified using ICD-9 and 10 codes.

For the analysis, fetal morbidity indicators of interest were preterm delivery and intrauterine growth restriction while investigators identified 21 indicated of severe maternal morbidity use the US Centers for Disease Control and Prevention (CDC) standard definition, which defined severe maternal morbidity as unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health, to serve as outcomes of interest.

From the NIS, investigators identified 10,297 unweighted SLE deliveries and 8,055,025 unweighted non-SLE deliveries, which resulted in weighted populations of 51,161 (95% CI, 49,419.14-52,903.37) SLE deliveries and 40,000,000 (95% CI, 39,200,000-40,700,000) non-SLE deliveries. Initial comparisons of the cohorts indicated patients with SLE were more likely to be older and have more comorbidities than their counterparts without SLE.

Upon analysis, results indicated patients with SLE had a greater risk of fetal morbidity than their counterparts without SLE, including a greater rate of intrauterine growth restriction (8.0% vs 2.7%) and preterm delivery (14.5% vs 7.3%). When using CDC maternal morbidity indicators, results suggested patients with SLE had a greater risk of blood transfusion, puerperal cerebrovascular disorders, acute renal failure, eclampsia, cardiovascular and peripheral vascular disorders, and general medical issues than their counterparts without SLE.

“Our study is not meant to discourage women with lupus from getting pregnant. We believe our findings can help both patients and their physicians to assess risk, establish appropriate interventions and ensure that a multidisciplinary medical team is in place to counsel patients and manage their care,” Mehta added.

This study, “Fetal and Maternal Morbidity in Pregnant Systemic Lupus Erythematosus Patients: A 10-Year US National Study,” was presented at EULAR 2022.