‘Exceedingly high’ lupus harms for mums and bubs

3 minute read

Despite improved maternal and fetal mortality, women with lupus and their babies still face vastly bigger risks of complications.

Women with systemic lupus erythematosus (SLE) are 15 times more likely to develop acute renal failure and 11 times more likely to have cardiovascular disorders when they have a baby, research suggests.  

The US study also found that women with lupus were almost four times more likely to need a blood transfusion or to develop a cerebrovascular disorder during delivery.  

And the babies of women with lupus have double the risk of having intrauterine growth restriction or being born prematurely, according to the 10-year study.  

“Despite extensive efforts over the years, there remains substantial risk for both maternal and fetal complications,” the US researchers wrote in RMD Open. 

“While our prior work showed notable improvement in the recent decade in SLE-related fetal and maternal mortality, morbidity remains exceedingly high.” 

The study included 51,000 women with lupus who delivered their babies in hospital. Researchers compared the data with that of 40 million women without lupus who delivered their babies in hospital.  

“Pregnant patients with SLE were about 15 times as likely to have acute renal failure (1.5% vs 0.1%), 11 times as likely to have cardiovascular and peripheral vascular disorders (1.1% vs 0.1%), four times as likely to receive a blood transfusion (4.0% vs 1.1%) or have puerperal cerebrovascular disorders (4.8% vs 1.1%),” the researchers said.  

They also found that women with SLE were more than three times as likely to have eclampsia or disseminated intravascular coagulation (1.2% vs 0.4%) and were more likely to have general medical issues (1.8% vs 0.5%) compared with women without SLE. 

Their babies had higher rates of intrauterine growth restriction, at 8% compared to 2.7% among their peers. They also had higher rates of pre-term delivery (before 37 weeks of gestation) at 14.5% compared to 7.3% in babies of women without SLE. 

The researchers also found that women with lupus were older (30 vs 28), more likely to be African American (24% vs 15%), and more likely to received Medicare (5% vs 0.7%) compared to women without lupus. 

The researchers said new management protocols and medications have been available since 2003, which may have improved outcomes.  

They found that since 2003, the proportion of patients with lupus who had pre-term labour decreased from 20.8% to 14.5%. However, the proportion of women with intrauterine growth restriction increased from 5.6% to 8%, eclampsia increased from 0.5% to 1.2%, and transfusion rates increased from 2.7% to 4%. 

“These differences may be due to several factors, such as transfusion thresholds, which may explain the observed increase in transfusion rates, or a higher proportion of patients carrying to term, which may explain the observed increase in IUGR,” they said.  

“A higher vigilance or better coding may have contributed to the higher rate of sepsis and stroke in our study.” 

The researchers said one limitation of the study was the lack of database information on lupus disease activity, Apgar scores, flares, the presence of nephritis, antiphospholipid or anti-Ro/SSA antibodies, or medications. 

Meanwhile, a US study on rheumatic disease in pregnancy published earlier this year recommended that women with rheumatoid arthritis or SLE be monitored closely for up to a year following delivery. 

That study found that women with rheumatic diseases were more likely to have preeclampsia and go into premature labour than women without rheumatic diseases, while their babies were more likely to be small for gestational age, be born preterm and spend time in a neonatal intensive care unit.

The researchers said disease flares may have contributed to the findings.  

RMD Open 2023, online 25 April 

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