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(HealthNewsDigest.com) – CHICAGO – Over the past two decades, maternal and fetal mortality, along with important clinical outcomes, have improved in pregnancies of women with systemic lupus erythematosus (SLE), according to new research findings presented this week at the 2018 ACR/ARHP Annual Meeting (Abstract #1852).
SLE, also called lupus, is a chronic disease that causes systemic inflammation that affects multiple organs. In addition to affecting the skin and joints, lupus can affect the kidneys, the tissue lining the lungs, heart and brain. Lupus flares vary from mild to serious, and most patients have times when the disease is active followed by times when the disease is mostly quiet, which is called remission. Lupus is far more common in women than men, and requires careful management during pregnancy.
For women with SLE, pregnancy has long been considered high-risk and associated with both medical and obstetric complications. Has the outlook for pregnant women with lupus improved in recent years? Researchers at academic medical centers around New York City conducted a study of national trends in medical and obstetric complications in pregnant women with SLE over the past two decades to find out.
“In the 1960s and 1970s, pregnancy was thought to be contraindicated in SLE patients,” said Bella Mehta, MBBS, MD, a rheumatologist at the Hospital for Special Surgery in New York and the study’s co-author. “Beginning in the 1980s, and especially in the 1990s, many studies identified specific risk factors for pregnancy complications and proposed best-practice management guidelines. We wished to see whether these advances improved pregnancy outcomes for SLE patients.”
The researchers analyzed yearly retrospective trends of cross-sectional data from the National Inpatient Sample (NIS) database from 1998-2014. They identified diagnoses and procedures using ICD-9 codes. They included pregnancy-related hospital admissions with or without SLE. They also studied complications including maternal mortality, cesarean section, pre-eclampsia or eclampsia, length of stay, and inflation-adjusted hospital charges.
The study included 87,065 pregnant women with SLE and 70,162,163 pregnant women without SLE who had been hospitalized in the U.S. during this 17-year time span. The SLE patients were older, and this group had a higher proportion of African-Americans, higher maternal mortality and higher intrauterine fetal death compared to those without SLE. The study also showed increased obstetric and maternal complications and comorbidities in the SLE patients compared to those without SLE.
However, the study showed a decline in maternal mortality and intrauterine fetal death over time, and this decline was greater in patients with SLE than those without lupus. Both women with SLE and those without SLE had an increase in cesarean sections, and this increase was less in the SLE patient group than the non-SLE group. The data showed that length of hospital stay decreased in SLE pregnancies over the study’s time span, but increased in non-SLE pregnancies.
“It is very encouraging to see steady improvement in maternal mortality and intrauterine fetal death, and to see that the improvements in fact outpaced improvements for non-SLE pregnancies, indicating that the new information is being adopted and is having an effect,” said Dr. Mehta. “Our study confirms that currently identifiable risk factors and pregnancy management practices can be used in counseling and pregnancy planning. Our data strongly supports wide use of the ACR Reproductive Health Guidelines that will be presented at the 2018 Annual Meeting. That SLE pregnancy risk is still higher than risk for non-SLE pregnancies indicates a need for continued research in this area.”
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