Grand Rounds

Have Pregnancy Risks Improved for Women with Lupus?

BACKGROUND AND PURPOSE:

While pregnant women with systemic lupus erythematosus (SLE) have better perinatal outcomes now than in the past, recent trends regarding other outcomes such preeclampsia rates are unknown
Mehta et al. (Annals of Internal Medicine, 2019) examined nationwide trends in maternal and fetal complications among pregnant women with SLE

Retrospective cohort study (1998 to 2015)
- National Inpatient Sample (NIS) database (sponsored by the AHRQ and the Healthcare Cost and Utilization Project)
Participants
- Pregnant women admitted to hospital
- With and without SLE
Data analysis
- Covariate data included co-morbidities, patient demographics, hospital characteristics and region
- Trends were assessed to look at outcomes over time
Primary outcomes: Temporal trends for the following
- In-hospital maternal mortality and fetal mortality
- Preeclampsia or eclampsia
- Cesarean sections
- Non–delivery-related admissions
- Length of stay (LOS)

93,820 pregnant women with SLE | 78,045,054 without SLE
In-hospital maternal deaths (per 100,000 admissions) declined among patients both with and without SLE
- With SLE
  - 1998 to 2000: 442 maternal deaths
  - 2013 to 2015: <50 maternal deaths
- Without SLE
  - 1998 to 2000: 13 maternal deaths
  - 2013 to 2015: 10 maternal deaths
- Decrease ‘dramatic’ in women with SLE (difference in trends, P < 0.002)
Fetal mortality rate declined among patients both with and without SLE
- With SLE
  - 1998 to 2000: 268 deaths per 10,000 deliveries
  - 2013 to 2015: 153 deaths per 10,000 deliveries
- Without SLE
  - 1998 to 2000: 72 deaths per 10,000 deliveries
  - 2013 to 2015 66 deaths per 10,000 deliveries
- Difference in trends was not statistically significant
Preeclampsia or eclampsia rates
- Decrease with SLE (9.5% to 9.1%) | Increase without SLE 3.3% to 4.1%)
C-section rates
- Increase with SLE (34.0% to 40.7%) | Increase without SLE (21.2% to 31.7%)
Hospital LOS
- Decrease with SLE (mean, 4.3 to 3.8 days) | Increase without SLE (mean, 2.5 to 2.7 days)

Authors acknowledge study limitations including
- Information on hospital-specific trends, SLE disease activity, and medications were not available
- Race trends could not be analyzed
- Incidence of outcomes reported may not be exact
Overall conclusions
- In-hospital maternal mortality and overall outcomes have improved for pregnant women with SLE
Risks of complications for women with SLE have significantly improved but still remain higher than those for women without SLE

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