Women with systemic lupus erythematosus (SLE) had more frequent miscarriages and other pregnancy complications than those with rheumatoid arthritis (RA) or healthy women, according to a recent study. SLE women also used fewer contraceptives, leading to more unplanned pregnancies that greatly increased the risk of complications for both mothers and babies.
The Sri Lankan study, “Pregnancy outcomes and contraceptive use in patients with systemic lupus erythematosus, rheumatoid arthritis and women without a chronic illness: a comparative study,” appeared in the International Journal of Rheumatic Diseases.
Even though SLE often strikes young women, the disease does not affect fertility rates much. However, most studies indicate that the symptoms of SLE may worsen during pregnancy, and that the risk of complications and death for both mother and fetus is higher.
Factors that put such pregnancies at risk include increased lupus activity, the presence of antiphospholipid antibodies, lupus nephritis (kidney inflammation) and unplanned pregnancies.
Women with RA, on the other hand, often improve during pregnancy, but no studies directly compare contraceptive usage and pregnancy outcome in patients with SLE and RA with those of healthy women.
A research team retroactively investigated pregnancy outcomes and contraceptive usage in 38 SLE patients from the National Hospital of Sri Lanka in Colombo, and compared them with 38 age-matched RA patients and healthy controls. The team used an interviewer-administered questionnaire as well as past clinical and obstetric records to collect data.
Results showed that only 45 percent of the babies from diagnosed SLE mothers survived, compared to 75 percent from RA mothers and 91 percent from healthy mothers. Miscarriage, premature birth, low birth weight and assisted deliveries occurred more often with SLE mothers, and the risk increased dramatically when antiphospholipid antibodies were present.
In addition, contraceptive usage was lower in SLE patients, which may have contributed to the fact that 80 percent of their pregnancies were unplanned, compared to RA patients (25 percent) and healthy women (9.4 percent).
Most studies report lower fetus survival rates among SLE mothers. In this sample, more than half of the babies whose mothers had SLE died. In contrast, all the babies born in planned pregnancies survived, suggesting that these pregnancies greatly increase the chance of successful outcomes.
“This study has shown that patients with SLE have high rates of fetal loss compared to patients with RA and WNCI [women with no chronic illness],” the team concluded. “Use of modern contraceptive methods in patients with SLE was much lower compared to patients with RA and WNCI, leading to more unplanned pregnancies occurring in patients with SLE. This study highlights the importance of a planned pregnancy during periods of disease remission in order to achieve an improved outcome for both the baby and the mother and the key role played by contraception to achieve these objectives.”