Lupus doubles risk for gestational diabetes during pregnancy
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Patients with systemic lupus erythematosus are at double the risk for gestational diabetes during pregnancy compared with those without SLE, according to data published in The Journal of Rheumatology.
“Globally, [gestational diabetes mellitus (GDM)] prevalence is increasing, partly due to older maternal age at pregnancy and higher prevalence of obesity and diabetes,” Sofie A.M. Gernaat, MSc, PhD, of the Karolinska Institute, in Stockholm, and colleagues wrote. “Insulin resistance is an important risk factor for GDM and is more common in women with systemic lupus erythematosus (SLE) than in women from the general population. Whether women with SLE have a higher risk of GDM than women from the general population remains unclear.”
To examine the risk for gestational diabetes among pregnant patients with SLE, compared to those without SLE, Gernaat and colleagues analyzed data from the population-based Swedish Lupus Linkage (SLINK) cohort and the Swedish Medical Birth Register. The researchers identified a total of 695 singleton pregnancies among patients with SLE, with a registered delivery date between Nov. 1, 2006, and Dec. 31, 2016, and matched each case with five non-SLE comparators from the general population, randomly sampled from the Total Population Register. Matches were made based on age, sex, calendar time and county.
Gernaat and colleagues defined gestational diabetes as at least one ICD-coded visit in the National Patient Register or Medical Birth Register. In addition, the researchers identified glucocorticoid and hydroxychloroquine dispensations within 6 months before and during pregnancy using the Prescribed Drug Register. Lastly, they used modified Poisson regression models, stratified by parity and adjusted for maternal age at delivery, year of birth and obesity to estimate risk ratios and confidence intervals for gestational diabetes associated with SLE.
According to the researchers, 2.6% of pregnancies among patients with SLE demonstrated gestational diabetes, compared with 1.4% among the 4,644 non-SLE matched control pregnancies. Adjusted risk ratios for gestational diabetes in the SLE population were 1.11 (95% CI, 0.38-3.27) for first deliveries and 2.03 (95% CI, 1.21-3.4) for all deliveries.
Among pregnancies in patients with SLE, gestational diabetes developed in 2.3% of those with at least one glucocorticoid dispensation before and/or during pregnancy, in 2.8% of those without glucocorticoids, in 2.4% of those with at least one hydroxychloroquine dispensation before and/or during pregnancy, and in 2.7% of those with hydroxychloroquine.
“Women with SLE are at an almost twofold higher risk of GDM compared to women from the general population when looking at all deliveries,” Gernaat and colleagues wrote. “Early and proper screening for GDM, including SLE as a risk factor for GDM, may be a way to manage women with SLE and reduce associated maternal and fetal complications. Future studies should investigate the risks of diseases later in life associated with GDM in women with SLE, such as the risk of type 2 DM and cardiovascular disease. Also, the long-term effects in the children born to mothers with GDM associated with SLE are unclear.”
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