Brief Report: Causes of Stillbirths in Women With Systemic Lupus Erythematosus

Abstract

Objective. There are few precise or recent estimates of the risk or causes of stillbirths in women with systemic lupus erythematosus (SLE). Thus, we undertook the present study to examine causes of stillbirths in mothers with SLE versus those without SLE.Methods. The Offspring of SLE Mothers Registry (OSLER) is a large population-based cohort, identified through Quebec's health care databases , including all women who had ‡1 hospitalization for delivery after SLE diagnosis, and a randomly selected control group of women matched for age and year of delivery. We identified stillbirths and ascertained the cause of death as indicated on death certificates. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated, and multivariate logistic regression analysis was performed to estimate the risk of stillbirth in women with SLE versus controls.Results. In our cohort, 509 women with SLE had 729 births, including 9 stillbirths, while 5,829 matched controls had 8,541 births, including 47 stillbirths. We observed more stillbirths in mothers with SLE than in controls (1.24% versus 0.55%, difference 0.69% [95% CI 0.03, 1.88]). Women with SLE had an increased risk of stillbirth compared to controls (adjusted OR 2.13 [95% CI 1.02, 4.45]). We also observed a trend toward more stillbirths due to placenta-mediated pregnancy complications in mothers with SLE than in controls (44% [95% CI 14, 79] versus 15% [95% CI 6, 28]).Conclusion. Compared to women from the general population, women with SLE have an increased risk of stillbirth. Stillbirths in women with SLE might be more often caused by placenta-mediated pregnancy complications compared to stillbirths in mothers without SLE.It is believed that pregnant women with systemic lupus erythematosus (SLE) have an increased risk of stillbirth, although there are few precise or recent estimates of the magnitude of the effect of SLE on stillbirth risk. Observational studies of pregnant women with SLE, most retrospective in design and including a limited number of subjects, have shown a wide-ranging prevalence of stillbirths, with estimates between 1% and 3% (1). In addition, these studies have mainly been conducted in tertiary care centers, and have not directly compared stillbirths occurring in women with SLE to a general population control group.Moreover, no study to date has investigated the causes of stillbirths in women with SLE. Pregnant women with SLE have an increased risk of certain placenta-mediated complications, such as preeclampsia and small-for-gestational-age (SGA) babies, as well as an increased risk of adverse obstetric outcomes, including premature rupture of membranes and preterm births (2). There are no data on the relative importance of these events as the cause of stillbirth in SLE. Therefore, using the Offspring of SLE Mothers Registry (OSLER), we examined causes of stillbirths in mothers with SLE versus in those without SLE. PATIENTS AND METHODSStudy design and subjects. OSLER is a populationbased cohort of 728 births occurring in mothers with SLE, ...

Damage accrual related to pregnancies before and after diagnosis of systemic lupus erythematosus: a cross-sectional and nested case-control analysis from a lupus registry

“…2,[5][6][7][8][9][10][11] SLE mainly affects young women of childbearing age, and adverse pregnancy outcomes (APOs), such as abortion, premature birth, stillbirth and termination, occur more often in women with SLE than in healthy women. 12,13 Some reports have shown disease activity, APS and GC usage as predictors for APOs. 14,15 A previous study showed that the pregnancy itself did not relate to chronic damage at the first visit after the deliveries, but chronic damage in patients with longer observation was not elucidated.…”

The association between active proliferative lupus nephritis during pregnancy and small for gestational age newborns

“…Intrauterine deaths in women with SLE occur earlier than in controls (median 29 weeks in patients with SLE versus 35 weeks in healthy patients) and are more frequent in cases of severe FGR (below the 3 rd percentile) or altered flow at foetal Doppler velocimetry (43,44). In this study, foetal deaths in patients with FGR were even earlier (26 weeks), with all SGA stillborn below the 3 rd percentile and 75% of them presented abnormalities in Doppler velocimetry.…”

Risk of adverse pregnancy outcomes in Japanese systemic lupus erythematosus patients with prior severe organ manifestations: A single-center retrospective analysis

“…Previous reports reveal that the APOs in SLE patients exceed that of the general population: SLE flare during pregnancy: 21.4%–64%, gestational hypertension: 0.99%–45%, gestational diabetes mellitus: 0%–11%, preeclampsia: 5.4%–20.2%, HELLP syndrome: 0.3%–0.66%, preterm birth: 9%–56%, spontaneous abortion: 0.4%–25%, SGA: 10%–28.5%, Apgar score less than 7 at 1 min: 1%–18% 3,4,8,19–26,28–49 We summarized the frequency of each APO in Table 5.…”