Preterm delivery nearly twice as common in patients with lupus vs. general population
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Preterm delivery occurs nearly twice as frequently among women with lupus compared with the general population, according to data presented at the EULAR 2022 Congress.
“As you all know, systemic lupus erythematosus is an autoimmune disorder that affects women of childbearing years,” Bella Mehta, MD, of the Hospital for Special Surgery and Weill Cornell Medicine, in New York, said in her presentation.
Mehta noted that her group has done research on pregnancy-associated mortality in lupus patients compared with the general population.
“In-hospital maternal mortality was declining in lupus patients compared with non-lupus patients,” she said. “Similarly, fetal mortality also was decreasing in lupus patients as compared with non-lupus patients.”
With that background in mind, Mehta and colleagues aimed to assess fetal and maternal morbidity in SLE, compared with the general population.
The retrospective analysis included more than 51,000 pregnancies among women with SLE and approximately 40 million pregnancies among individuals without lupus over the last 10 years. Findings were culled from the National Inpatient Sample database.
“This is basically capturing all deliveries in the U.S. over the last decade,” Mehta said.
Patients with lupus were aged approximately 30 years, which was 1 year older than the age at delivery for the general population, according to the findings.
Results for maternal outcomes showed that blood transfusions were more common in the lupus group, compared with the non-lupus group — 4% vs. 1.1% — while acute renal failure was also higher in patients with lupus — 1.5% vs. 0.1%.
Similar outcomes among mothers were reported for puerperal cerebrovascular disorders — 4.8% vs. 1.15 — eclampsia and DIC — 1.3% vs. 0.4% — cardiovascular and peripheral vascular disorders — 1.1% vs. 0.1% — and general medical issues — 1.8% vs. 0.5% — with the higher rates all seen in the lupus group.
“As you can see, most non-lupus deliveries have zero comorbidities,” Mehta said. “Whereas the ones with lupus have much higher comorbidity indexes.”
Turning to fetal morbidity, intrauterine growth restriction occurred in 8% of newborns of patients with lupus and 2.7% of those from the general population. Preterm delivery was also higher in the lupus group — 14.5% vs. 7.3%.
“The preterm delivery rates are almost double,” Mehta said.
The study is limited by the failure to capture outpatient deliveries.
“Also, we do this using billing information and ICD-9 codes, so there is some amount of bias that can occur,” Mehta said.
Lupus disease activity, flare rates, antibody levels and medication use also were not included in the analysis.
However, Mehta suggested that the results send a definite signal.
“It does give a clear picture of a large number of pregnancies all over the U.S.,” she said. “Fetal morbidity and CDC-defined severe morbidity appeared to occur at a higher rate in patients with lupus compared to those without lupus.”
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Mehta B. Fetal and Maternal Morbidity in Pregnant Systemic Lupus Erythematosus (SLE) Patients: A 10-year U.S. National Study. Presented at: EULAR 2022 Congress; June 1-4, 2022 (virtual meeting).
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