High morbidity in pregnant lupus patients and their unborns

Pregnancy in SLE have a 3-fold risk of fetal intrauterine growth restriction and 2-fold premature birth risk compared with healthy women.

Maternal and foetal mortality rates for SLE patients in decline, but morbidity had remained unclear

In-hospital maternal and foetal mortality rates for women with SLE have declined over the past decades, but is this also true for morbidity? To answer this question, Prof. Bella Mehta (Weill Cornell Medical College, NY, USA) 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 and delivery-related hospital admissions.

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. Of the women with SLE, 8% of their foetuses had intrauterine growth restriction (compared with 2.7% in women without SLE).

Pregnant SLE patients: 4x as likely to require a transfusion or develop a cerebrovascular disorder; 15x as likely to develop acute renal failure

Not only the babies but also the pregnant SLE patients faced considerable health risks during the pregnancy. Compared with women without SLE, they were 4x as likely to require a transfusion or develop a cerebrovascular disorder and 15x as 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. Metha pointed out that the database, unfortunately, did not include information on lupus disease activity, SLE flares, the presence of nephritis, 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. Metha concluded.

1. Metha B, et al. Fetal and maternal morbidity in pregnant systemic lupus erythematosus (SLE) patients: a 10-year US national study. OP0124, EULAR 2022, 1–4 June, Copenhagen, Denmark.