What to Expect When Expecting With Systemic Lupus Erythematosus (SLE): A Population‐Based Study of Maternal and Fetal Outcomes in SLE and Pre‐SLE

Abstract

ObjectiveTo assess maternal and fetal outcomes associated with subclinical (pre‐systemic lupus erythematosus [SLE] and SLE presenting up to 5 years postpartum) and prevalent maternal SLE during pregnancy compared with the general population.MethodsThis prospective cohort study used population‐based Swedish registers to identify 13,598 women with first singleton pregnancies registered in the Medical Birth Register (551 prevalent SLE, 65 pre‐SLE within 0–2 years, 133 pre‐SLE within 2–5 years, and 12,847 general population). SLE was defined as ≥2 SLE‐coded discharge diagnoses in the patient register with ≥1 diagnosis from a specialist. Unadjusted risks of adverse pregnancy or birth outcomes were calculated by SLE status, and Cochran‐Armitage tests evaluated trend across exposure groups.ResultsMaternal outcomes such as preeclampsia, hypothyroidism, stroke, and infection were more common among women with SLE. Sixteen percent of prevalent‐SLE pregnancies were diagnosed with preeclampsia compared with 5% of those from the general population. Among the pre‐SLE women, preeclampsia was found in 26% of those with SLE within 2 years postpartum and 13% in those with SLE within 2–5 years postpartum. Similarly, infant outcomes, such as preterm birth, infection, and mortality, were worse among those born to mothers with prevalent SLE and pre‐SLE during pregnancy. The test for trend was significant for most outcomes.ConclusionOur data demonstrate that adverse maternal and fetal outcomes are more common in SLE pregnancies. Furthermore, these unfavorable outcomes are observed in pregnancies occurring prior to the diagnosis of SLE. Thus, the underlying immunologic profile of SLE and alterations preceding clinical SLE may contribute to these pregnancy complications.

A Population‐based Study of Perinatal Infection Risk in Women with and without Systemic Lupus Erythematosus and their Infants

“…Passage of IgG from the mother to the baby increases dramatically with advancing gestational age, which partly explains why preterm infants have greater infection risk . A recent study utilising Swedish birth registries reported that 21% of singleton births to women with SLE were complicated by infant infections, although this study did not address the interaction of preterm birth and infection . In our study, preterm birth was likely a major, but not the sole mechanism leading to infection in neonates of women with SLE.…”

“…6 A recent study utilising Swedish birth registries reported that 21% of singleton births to women with SLE were complicated by infant infections, although this study did not address the interaction of preterm birth and infection. 19 In our study, preterm birth was likely a major, but not the sole mechanism leading to infection in neonates of women with SLE. Risk estimates for infection during the birth hospitalisation, infection or sepsis in the neonatal period, and receipt of anti-sepsis antibiotics remained increased, but were considerably attenuated, after accounting for preterm delivery.…”

Clinical presentation of autoimmune disorders in pregnancy

“…These two medical disorders are reported to be more common in pregnancies with autoimmune disorders than without. 9 Three patients were on oral steroid medications throughout the pregnancy. Steroids have been reported to improve the rate of live births in some studies.…”

Early‐onset Preeclampsia in Lupus Pregnancy

“…In a descriptive study of first singleton births in this population, we recently reported that 16% of the SLE exposed pregnancies had a preeclampsia diagnosis compared to just under 5% of those from the non-SLE general population comparator. 18 Other investigators have used a variety of data sources to examine composite adverse pregnancy outcomes in SLE patients, but not specifically early-onset preeclampsia and not always as the primary outcome. 13,19 We found between a two-and threefold increased risk of any preeclampsia in our analysis, which is consistent with previous studies of any preeclampsia in SLE pregnancy and clinical practice expectations.…”