A National study of the complication of lupus in pregnancy

Department of Medicine, Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC 27710, USA.
American journal of obstetrics and gynecology (Impact Factor: 3.97). 06/2008; 199(2):127.e1-6. DOI: 10.1016/j.ajog.2008.03.012
Source: PubMed

ABSTRACT This study was undertaken to determine the risk of rare complications during pregnancy for women with systemic lupus erythematosus.
By using the Nationwide Inpatient Sample from 2000-2003, we compared maternal and pregnancy complications for all pregnancy-related admissions for women with and without systemic lupus erythematosus.
Of more than 16.7 million admissions for childbirth over the 4 years, 13,555 were to women with systemic lupus erythematosus. Maternal mortality was 20-fold higher among women with systemic lupus erythematosus. The risks for thrombosis, infection, thrombocytopenia, and transfusion were each 3- to 7-fold higher for women with systemic lupus erythematosus. Lupus patients also had a higher risk for cesarean sections (odds ratio: 1.7), preterm labor (odds ratio: 2.4), and preeclampsia (odds ratio: 3.0) than other women. Women with systemic lupus erythematosus were more likely to have other medical conditions, including diabetes, hypertension, and thrombophilia, that are associated with adverse pregnancy outcomes.
Women with systemic lupus erythematosus are at increased risk for serious medical and pregnancy complications during pregnancy.

Download full-text


Available from: Andra H James, Aug 16, 2015
  • Source
    • "Notable exceptions are two analyses of nationwide obstetric hospitalization data in the US. These studies demonstrate that women with SLE were significantly older than controls but, even after adjusting for age, were at increased risk of hypertensive disorders including preeclampsia, cesarean delivery, preterm delivery and IUGR compared to the general obstetric population [21] [65]. Other fetal outcomes could not be assessed in these studies. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There are multiple epidemiological studies that document the potential adverse affects of autoimmunity on nearly every aspect of reproduction, even in the absence of clinically manifest autoimmune disease. Two decades ago, it was suggested that women with autoimmune diseases avoid pregnancy due to inordinate risks to the mother and the child. In contrast, newer epidemiological data demonstrated that advances in the treatment of autoimmune diseases and the management of pregnant women with these diseases have similarly improved the prognosis for mother and child. In particular, if pregnancy is planned during periods of inactive or stable disease, the result often is giving birth to healthy full-term babies without increased risks of pregnancy complications. Nonetheless, pregnancies in most autoimmune diseases are still classified as high risk because of the potential for major complications. These complications include disease exacerbations during gestation and increased perinatal mortality and morbidity in most autoimmune diseases, whereas fetal mortality is characteristic of the anti-phospholipid syndrome (APS). In this review, we will discuss these topics, including issues of hormones, along with potential long-term effects of the microchimerism phenomenon. With respect to pregnancy and autoimmune diseases, epidemiological studies have attempted to address the following questions: 1) Is it safe for the mother to become pregnant or are there acute or chronic effects of pregnancy on the course of the disease? 2) Does the disease alter the course and/or the outcome of a pregnancy and thereby represent an inordinate risk for the fetus and infant? And do new therapeutic and management approaches improve the pregnancy outcomes in women with autoimmune diseases? 3) Does passage of maternal autoantibodies represent a risk to the child? 4) Do pregnancy, parity, or other factors influencing hormonal status explain the female predominance of many autoimmune diseases, and is the pregnancy effect related to microchimerism? Answering these questions has taken on additional importance in recent decades as women in western countries now frequently choose to delay pregnancies and have some or all of their pregnancies after disease onset. In this paper, we primarily focus on APS, systemic lupus erythematosus (SLE), multiple sclerosis (MS), rheumatoid arthritis (RA), and type 1 diabetes (T1D).
    Journal of Autoimmunity 05/2010; 34(3):J287-99. DOI:10.1016/j.jaut.2009.11.015 · 7.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Systemic autoimmune diseases (SAD) are complex conditions with the ­potential for severe multiorgan involvement. Many patients are young women, thus potentially subject to one or more pregnancies during the course of their disease. An integrated multidisciplinary approach is essential in order to assure a correct diagnosis and management of pregnancy complications in this group of women.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Behandlungsmöglichkeiten entzündlich-rheumatischer Erkrankungen wie der rheumatoiden Arthritis, Spondylitis ankylosans und des systemischen Lupus erythematodes verbessern sich stetig. Dies führt auch dazu, dass sich eine wachsende Zahl der oft jungen Patientinnen ihren Kinderwunsch erfüllen möchte. Das zunehmende Verständnis der Erkrankungsverläufe in der Schwangerschaft bzw. postpartal erlaubt eine optimierte Beratung der betroffenen Frauen vor Konzeption. Von entscheidender Bedeutung sind die Planung einer Schwangerschaft in einer möglichst inaktiven Erkrankungsphase und eine regelmäßige Überwachung. Dabei sind die sorgfältige Einschätzung möglicher Risiken und die Aufklärung über den Einsatz von antirheumatischen Therapien vor, während und nach einer Gravidität wichtige Bestandteile.
    Der Internist 07/2013; 53(9). DOI:10.1007/s00108-012-3029-2 · 0.27 Impact Factor
Show more