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 . To clarify this topic, Prof. Mehta performed a retrospective study using data on 40 million delivery-related admissions from a US database . 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 
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.
- Mehta B, et al. Ann Intern Med. 2019;171:164–71.
- 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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Table of Contents: EULAR 2022
Letter from the Editor
EULAR 2022 Highlights Podcast
Late-Breaking Oral Abstracts
TYK2 inhibition: the future of treating lupus erythematosus?
Psoriatic arthritis: significant improvement with bimekizumab
Baricitinib could open the door to oral treatment for juvenile idiopathic arthritis
Sarilumab for polymyalgia rheumatica led to sustained remission and fewer flares
Spotlight on Rheumatoid Arthritis
Comorbid depression comes with a profoundly higher mortality risk in RA
Preventive treatment with methotrexate benefits pre-RA patients with arthralgia
Risk factors for dementia in RA patients discovered
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Spondyloarthropathies – Novel Developments
How to treat enthesitis in 2022
Baseline cardiovascular risk linked to higher rates of MACE in PsA and PsO patients receiving tofacitinib
Treat-to-target dose reduction effective in spondyloarthritis
A novel oral treatment possibility for non-radiographic axSpA on the horizon
Many RA and PsA patients have problems with their sex life
What Is Hot in Osteoarthritis?
New treatments in osteoarthritis
OA associated with alcohol and drug abuse
Body mass index increase associated with structural changes in knee OA
What Is New in Lupus and Scleroderma
Inhibition of Bruton’s tyrosine kinase: a new way of approaching SLE?
Pregnancies in SLE: many complications for mothers and their unborn children
Lupus nephritis: Efficient treatment may reduce the risk of kidney disease advancement
Antifibrotic therapy with nintedanib is beneficial for patients with negative prognostic factors
Best of The Posters
Alarmingly low activity in patients with non-inflammatory and inflammatory rheumatic disease
High prevalence of fibromyalgia in patients with inflammatory bowel disease
Upadacitinib: data from U-ACHIEVE and CELEST
Better results for vedolizumab in early CD
Moving towards new therapeutic options