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Lupus Linked to Higher Risk of Problems in Pregnancy


 

WASHINGTON — Women with lupus are at increased risk for thrombosis, infection, hematologic disorders, and death during pregnancy, according to data from the large National Inpatient Survey, Dr. Megan E.B. Clowse reported at the annual meeting of the American College of Rheumatology.

The National Inpatient Survey (NIS), which is administered by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, contains data from 1,000 hospitals nationwide.

Out of more than 18.3 million pregnancy-related hospital admissions between 2000 and 2002 in the United States, 17,262 (0.01%) involved women with systemic lupus erythematosus (SLE), according to Dr. Clowse, a rheumatologist at Duke University, Durham, N.C.

Analysis of data from the NIS revealed that women with SLE who become pregnant were significantly more likely also to have other underlying medical conditions that are associated with adverse outcomes, including renal failure (odds ratio 35.8), antiphospholipid syndrome (odds ratio 31.9), hypertension (odds ratio 6.4), and diabetes (odds ratio 1.6), according to Dr. Clowse.

They were also more likely to experience complications during pregnancy (see table).

More than one-third had cesarean births, and preeclampsia was three times higher among the SLE patients than among non-SLE women, at 23%. Eclampsia developed in only a small percentage of lupus patients (0.5%), but this was still four times more common than in nonaffected women.

Moreover, women in the survey with SLE had demographic factors that may predispose them to more medical problems during pregnancy. They were older, with a mean age of 30 years, compared with 27.5 years in the general pregnancy population, and more were African American (20%) than in the general pregnancy population (14%).

The observation that pregnancy poses risks to women with SLE is not surprising, Dr. Clowse wrote in a poster session. After all, lupus itself increases the risk of death in women of reproductive age by up to 12 times, regardless of pregnancy, and also heightens the risk of infection, thrombosis, and hematologic complications.

But the absolute risk of death during pregnancy remains low, at 0.3%, while the annual mortality among SLE patients ranges from 0.8% to 3%.

“The risk of death during pregnancy may actually be lower than during nonpregnancy for SLE patients, because the sickest patients do not get pregnant,” Dr. Clowse observed.

Nonetheless, pregnancy does carry risk for patients with lupus, and they should be followed closely by a rheumatologist and an obstetrician who specializes in high-risk pregnancies.

Also, because of the risk of thrombosis, consideration should be given for all pregnant SLE patients to have prophylaxis with low-dose aspirin, she noted.

Dr. Clowse disclosed that she had no conflicts of interest.

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