Lupus During Pregnancy Raises Chance of Complications for Mother, Child

Lupus during pregnancy increases the likelihood of health complications for women and their babies, according to a study, “What to expect when expecting with SLE: A population-based study of maternal and fetal outcomes in SLE and pre-SLE,” published in the journal Arthritis Care and Research.

Adverse pregnancy outcomes have previously been reported in mothers with systemic lupus erythematosus (SLE) and their offspring, including pre-eclampsia and  preterm birth. As many of these adverse events can impact life quality, a better understanding of pregnancy risks and potential outcomes is essential for SLE patients.

To investigate maternal and fetal health related with subclinical (pre-SLE, or SLE presenting up to five years postpartum) and prevalent maternal SLE during pregnancy in comparison to the general population, researchers — led by Julia Simard from the Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute in Stockholm, Sweden — used a population-based Swedish registers to identify 13,598 women pregnant with their first child, a single birth. Of these, 551 women had prevalent SLE, 65 were found to be pre-SLE within two years, and 133 were pre-SLE within two to five years.

Stroke, pre-eclampsia, infection and hypothyroid disease were more common among women with a diagnosis of SLE. In fact, 16 percent of prevalent SLE pregnancies were diagnosed with pre-eclampsia compared to 5 percent of the general population. Among women with pre-SLE, pre-eclampsia was present in 26 percent of patients within two years postpartum, and 13 percent between two and five years after childbirth.

Worse outcomes were also found in infants born to women with prevalent SLE and pre-SLE during pregnancy, including premature birth, infection, and higher mortality.

According to the researchers, the results confirm previous findings of maternal and fetal risks in SLE pregnancy. “Our findings suggest that immunologic activity, such as autoantibodies, contribute to these complications even in the absence of a clinical diagnosis of lupus,” Dr. Julia Simard, senior author of the study, said in a news release. “We are now trying to understand not only how this might impact the time to lupus diagnosis but also what we can learn about outcomes such as pre-eclampsia or preterm birth more generally.”