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Pregnancy outcomes in women with lupus significantly improved in last 18 years

Maternal mortality drastically decreased and overall pregnancy outcomes improved in women with systemic lupus erythematosus during the last 18 years, according to a study published in the Annals of Internal Medicine.

“Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that predominantly affects women of child-bearing age,” Bella Mehta, MBBS, MS, of the Hospital for Special Surgery and Weill Cornell Medicine, Yiming Luo, MD, of Mount Sinai St. Luke's, Mount Sinai West, and Icahn School of Medicine, and colleagues wrote. “Pregnancy in SLE was once considered so high risk that physicians counseled women against it and even advised pregnancy termination. Pregnancy in women with SLE still carries higher maternal and fetal risk than it does in healthy women.”

Researchers conducted a retrospective cohort study using discharge data from the National Inpatient Sample database to evaluate trends in medical and fetal complications in patients with SLE from 1998 to 2015. Data from the National Inpatient Sample represented 95% of the population of the United States.

Outcomes including in-hospital maternal mortality, fetal mortality, nondelivery-related hospital admissions, preeclampsia or eclampsia, cesarean sections, and length of stay were evaluated and compared in pregnant women with and without SLE.

Researchers estimated that among pregnant women, 93,820 with SLE and 78,045,054 without SLE were hospitalized between 1998 and 2015.

During the study period, in-hospital maternal deaths decreased in women without SLE, (from 13 deaths per 100,000 admissions in 1998 to 2000, to 10 deaths per 100,000 admissions in 2013 to 2015) and significantly decreased in those with SLE (442 deaths per 100,000 admissions in 1998 to 2000 vs. < 50 deaths per 100,000 admissions in 2013 to 2015).

Both groups experienced decreases in fetal mortality that were not statistically different between those with and without SLE. The rate of preeclampsia or eclampsia decreased in patients with SLE (9.5% to 9.1%) and increased in those without SLE (3.3% to 4.1%).

Nondelivery-related hospital admissions decreased in patients with SLE (19.2% to 16.4%) and in women without SLE (8.4% to 5.5%). Length of hospital stay decreased in women with SLE (mean, 4.3 to 3.8 days) and increased in those without SLE (mean, 2.5 to 2.7 days).

Researchers noted that the significantly larger improvement in maternal mortality among women with SLE compared with those without SLE suggests that factors beyond developments in obstetrics were responsible for improved maternal mortality in those with SLE.

“Mehta and colleagues have demonstrated important improvements in maternal and fetal mortality by using one of the few data sets large enough to study these rare events,” Megan E.B. Clowse, MD, MPH, of Duke University Medical Center, wrote in an editorial accompanying the study. “Work still must be done, however, regarding preeclampsia and fetal and maternal mortality, each of which is several times more common in women with SLE than in those without the disease.” – by Erin Michael

Disclosures: Clowse reports grants from GlaxoSmithKline and personal fees from UCB outside the submitted work. Mehta reports no relevant financial disclosures.