Pregnancy outcomes in women with systemic lupus erythematosus

Yasmeen, Shagufta; Wilkins, E. E.; Field, Nancy T.; Sheikh, Rafiq A.; Gilbert, W.M.

doi:10.1080/jmf.10.2.91.96

Cited by 125 publications

(54 citation statements)

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“…Additionally, the rate of hypertensive disorders found in the control population (0.4%) in their study was well below the rate of 7.8% in our study, which approximated the established rate of 6-8% in the general population of the US (20). The strengths of the study by Yasmeen et al (32) were the large number of hospitalizations available for analysis as well as the ability to link maternal and neonatal/infant discharge records. Limitations resulted from the extremely low rates of hypertensive disorders seen in both the SLE and control populations and the fact that regression analyses of associations between SLE and adverse outcomes of pregnancy were restricted to univariate analyses.…”

Section: Discussioncontrasting

confidence: 52%

Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis

Chakravarty

Nelson

Krishnan

2006

Arthritis & Rheumatism

237

136

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Objective. To estimate the national occurrence of pregnancies in women with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and to compare pregnancy outcomes in these patients with those in women with pregestational diabetes mellitus (DM) and with the general obstetric population.Methods. We studied the 2002 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project to estimate the number of obstetric hospitalizations, deliveries, and cesarean deliveries in women with SLE, RA, pregestational DM, and the general obstetric population. Pregnancy outcomes included length of hospital stay, hypertensive disorders including preeclampsia, premature rupture of membranes, and intrauterine growth restriction.Results. Of an estimated 4.04 million deliveries, 3,264 occurred in women with SLE, 1,425 in women with RA, and 13,574 in women with pregestational DM. Women with SLE, RA, and pregestational DM had significantly increased rates of hypertensive disorders compared with the general obstetric population (23.2%, 11.1%, 27.4%, and 7.8%, respectively), longer hospital stays, and significantly higher risk of cesarean delivery. Although women with SLE, RA, and pregestational DM were significantly older than women in the general obstetric population, disparities in the risk of adverse outcomes of pregnancy remained statistically significant after adjustment for maternal age.Conclusion. To our knowledge, this is the first study to examine national data on pregnancy outcomes in women with common rheumatic diseases. As with underlying pregestational DM, women with SLE and RA appear to have a higher age-adjusted risk of adverse outcomes of pregnancy and longer hospital stays than do pregnant women in the general population, and careful antenatal monitoring should be performed.Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are chronic autoimmune diseases that have a strong female predominance and commonly affect women of childbearing age. The prevalence of SLE in the US is estimated to be ϳ1-4 per 1,000 women (1,2), with the peak age at onset during the childbearing years. Studies have consistently shown that women comprise 90% of all lupus patients. With the exception of premature ovarian failure due to therapy with alkylating agents, fertility rates for women with SLE are normal (3). Pregnancy outcomes in women with SLE have been studied extensively in specialty clinic settings, and the results have been mixed with regard to the effects of pregnancy on disease flares in women with SLE (4,5). Most, although not all, studies have shown an increased occurrence of pregnancy loss, premature delivery, and preeclampsia in pregnant women with SLE (6-10). The majority of studies examining SLE pregnancies have been prospective or retrospective analyses of pregnant women followed up at tertiary-care academic centers and may not reflect the spectrum of pregnancy experiences across the country (6-10). Furthermore, because of the small number of pregnant patients at any given center or hospital ...

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Section: Discussioncontrasting

confidence: 52%

Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis

Chakravarty

Nelson

Krishnan

2006

Arthritis & Rheumatism

237

136

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“…Previous studies have reported increased frequency of complications such as preeclampsia, eclampsia, renal disease, preterm delivery, non-elective cesarean section, postpartum hemorrhage, low birth weight and delivery-related deep vein thrombosis. Hypertensive complications of pregnancy occur in approximately 10% to 20% of all pregnant women with lupus (8,9). Our patient did not develop eclampsia or preeclampsia, however, she had a preterm delivery at 37th week of gestation, which is consistent with previously reported literature.…”

Section: Discussionsupporting

confidence: 92%

Vasculitic Neuropathy in a Third Trimester Pregnant Patient with Systemic Lupus Erythematosus

et al. 2014

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“…Whether SLE activity increases during pregnancy has been a matter of debate over the last years although recent studies have found a two-to threefold increase in SLE activity during pregnancy [4,[10][11][12]. Differentiation of signs and symptoms of normal pregnancy from those of exacerbations of lupus (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…chloasma vs. malar rash, proteinuria secondary to preeclampsia vs. proteinuria due to lupus nephritis) can be particularly difficult, which clearly constitutes a bias when assessing reported incidence and prevalence rates. On the other hand, in the past, many patients used to stop all their therapy upon discovering that they were pregnant which may have contributed to an increased risk of flare in pregnancy [10,11,13].…”

Section: Discussionmentioning

confidence: 99%

Lupus and Pregnancy—15 Years of Experience in a Tertiary Center

Ambrósio¹,

Lermann²,

Cordeiro³

et al. 2009

Clinic Rev Allerg Immunol

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This retrospective study was designed to evaluate the outcome of pregnancies in women diagnosed with systemic lupus erythematosus (SLE) followed in a tertiary fetal-maternal center. Data were collected from clinical charts between January 1993 and December 2007, with a total of 136 pregnancies (107 patients). Mean maternal age was 29 years, with the vast majority of patients being Caucasian. Most patients were in remission 6 months prior to pregnancy (93%) and the most frequently affected organs were the skin and joints. Renal lupus accounted for 14% of all cases. Twenty-nine percent of patients were positive for at least one antiphospholid antibody (aPL) and nearly 50% had positive SSa/SSb antibodies. All patients with positive aPL received low-dosage aspirin and lowmolecular-weight heparin (LMWH). There were no pregnancy complications in more than 50% of cases and hypertensive disease and intrauterine growth restriction were the most common adverse events. There were 125 live births, one neonatal death, eight miscarriages, and three medical terminations of pregnancy. Preterm delivery occurred in 25% of pregnancies. Our results are probably the conjoined result of a multidisciplinary approach together with a systematic management of SLE pregnancies, with most patients keeping their prior SLE medication combined with low-dosage aspirin and LMWH in the presence of aPL.

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Pregnancy outcomes in women with systemic lupus erythematosus

Cited by 125 publications

References 0 publications

Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis

Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis

Vasculitic Neuropathy in a Third Trimester Pregnant Patient with Systemic Lupus Erythematosus

Lupus and Pregnancy—15 Years of Experience in a Tertiary Center

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