Pregnancies in SLE: many complications for mothers and their unborn children

Pregnant women with systemic lupus erythematosus (SLE) have an increased risk of adverse pregnancy and neonatal outcomes, emphasising the need for specialised management of these patients. This was the main result of a retrospective study of over 50,000 women with SLE and delivery-related hospital admissions.

“As you all know, SLE affects women in their childbearing years,” Prof. Bella Mehta (Weill Cornell Medical College, NY, USA) said in her introduction. In a previous study, she and her team found that in-hospital maternal and foetal mortality rates for women with SLE have declined over the past decades, but whether this is also true for morbidity is unclear [1]. To clarify this topic, Prof. Mehta performed a retrospective study using data on 40 million delivery-related admissions from a US database [2]. The researchers identified all delivery-related hospital admissions for patients with and without SLE from 2008 through 2017. Over 50,000 women had a diagnosis of SLE.

Patients with SLE were more likely to be older and had more comorbidities compared with non-SLE patients. Their risk of foetal morbidity was markedly elevated: 14.5% of the foetuses from SLE mothers were born prematurely compared with 7.3% in women without SLE (see Figure). Of the women with SLE, 8% of their foetuses had intrauterine growth restriction compared with 2.7% in women without SLE.

Figure: Foetal and severe maternal morbidity outcomes in SLE and non-SLE patients [2]



 

 

 

 

 

 

 

 

 

 

SLE, systemic lupus erythematosus; DIC, disseminated intravascular coagulation.

Not only the babies but also the pregnant SLE women faced considerable health risks during the pregnancy. Compared with women without SLE, they were 4 times more likely to require a transfusion or develop a cerebrovascular disorder and 15 times more likely to develop acute renal failure. Other complications that were more frequent in pregnant women with SLE were eclampsia, disseminated intravascular coagulation, and cardiovascular and peripheral vascular disorders. Moreover, general medical issues like shock, sepsis, adult respiratory distress syndrome, and severe anaesthesia complications were more frequent in SLE patients compared with women without SLE.

Prof. Mehta pointed out that the database, unfortunately, did not include information on SLE disease activity, flares, the presence of nephritis, antiphospholipid or anti-Ro/SSA antibodies, or medication use, which is a limitation of this study. “However, this work can help inform physicians to counsel and manage patients with SLE during pregnancy,” Prof. Mehta concluded.

1. Mehta B, et al. Ann Intern Med. 2019;171:164–71.
2. Mehta B, et al. Fetal and maternal morbidity in pregnant systemic lupus erythematosus (SLE) patients: a 10-year US national study. OP0124, EULAR 2022 Congress, 1–4 June, Copenhagen, Denmark.

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Posted on 21 July 202217 May 2024