According to a recent study analyzing U.S. data, women with systemic lupus erythematosus (SLE) are at higher risk for maternal and fetal morbidity compared to those without the chronic autoimmune disorder. The study, which spanned over 10 years and looked at 40 million delivery-related hospital admissions, including over 50,000 involving women with SLE, found that patients with SLE had higher rates of intrauterine growth restriction versus those without SLE (8.0% vs. 2.7%) and more frequent preterm delivery (14.5% vs. 7.3%).
The study, led by Bella Mehta, MD of Weill Cornell Medical College and Hospital for Special Surgery in New York City, found that mothers with SLE were almost four times as likely to require a blood transfusion or develop a cerebrovascular disorder, and 15 times as likely to develop acute renal failure compared with those without SLE. Despite a decrease in maternal and fetal mortality in lupus patients over the past two decades, morbidity for this population remains “exceedingly high,” according to the researchers.
The study aimed to quantify the actual risk to pregnant women with SLE and found that multidisciplinary care is key for SLE patients during pregnancy and beyond. Mehta urged clinicians to work together across disciplines to care for patients with SLE who want to bear children. While the study highlights the risks associated with SLE during pregnancy, Mehta emphasized that it should not deter patients from pursuing pregnancy but rather be used to manage patients better and work in a multidisciplinary fashion to mitigate these risks.
The study also revealed that compared with patients without SLE, patients with SLE were older (30.1 vs. 28.2 years) and more likely to be African American (24.7% vs. 15%). SLE patients were also more likely to undergo care at urban teaching hospitals (70.5% vs. 56.2%) and a higher percentage received Medicare (5.3% vs. 0.7%).
Veronica Gillispie-Bell, MD of Ochsner Health Center in Kenner, Louisiana, agreed with Mehta that multidisciplinary care is essential for SLE patients during pregnancy and beyond. Gillispie-Bell also emphasized the importance of asking women of reproductive age about their pregnancy intention so that their medical conditions can be addressed.
A limitation of the study was that some cases may have been misclassified, as the study used billing information and discharge diagnosis from the National Inpatient Sample (NIS), which does not capture outpatient deliveries, early pregnancy loss, or miscarriage. Nonetheless, the study highlights the need for multidisciplinary care and management of patients with SLE who want to bear children.
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