Systemic Lupus Erythematosus Affects Child Birth

Mothers with systemic lupus erythematosus, or SLE for short, have more than double the risk of having a premature or growth-restricted baby, according to a 10-year nationwide audit of hospital admissions records in the United States published online in the open access journal RMD Open.
According to the audit, these mothers are roughly four times more likely to require a blood transfusion and 15 times more likely to develop kidney failure during delivery than mothers who do not have the disorder.

According to the researchers, rates of death and serious disease among new moms are growing in the United States, most likely due to rising rates of obesity, underlying illnesses, and older age at parenthood. Despite evidence that maternal and fetal fatalities have decreased in women with SLE, it is unclear if rates of severe illness have decreased in comparison to women without the condition.
To find out, the researchers used data from the National Inpatient Sample (NIS) from 2008 to 2017. The NIS is the largest publicly available inpatient database in the United States, with information on over 7 million hospital stays every year, representing over 35 million admissions.
Between 2008 and 2017, an estimated 51,161 pregnant women with SLE were admitted to the hospital to give birth (based on unweighted numbers of 10,297).

Women with SLE were older (30 vs 28), of African American descent (25% vs 15%), and more likely to be eligible for Medicare (5% vs nearly 1%).

The majority were treated at an urban teaching hospital or a medium or large-sized hospital. And, according to the Elixhauser Comorbidity Index, 45.5% had co-existing conditions, compared to 4%.

Pregnant women with Systemic Lupus Erythematosus were more than three times more likely to experience eclampsia or abnormal blood clotting throughout the body’s blood vessels (disseminated intravascular coagulation), as well as other medical problems. They were also 11 times more likely to suffer from cardiovascular and peripheral vascular disease.

Their babies were also more likely to be growth-restricted (8% vs nearly 3%) and to be born premature (14.5% vs 7%) than those of mothers without SLE.

“Despite extensive efforts over the years, there remains a substantial risk for both maternal and fetal complications,” say the researchers.

They conclude, “Our study demonstrates that fetal morbidity and severe maternal morbidity occur at a higher rate in patients with SLE compared with those without. This quantitative work can help inform and counsel patients with SLE during pregnancy and planning.”

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