Teens, Young Women with SLE Have Higher Risk of Adverse Pregnancy Outcomes, Study Shows

Teen and young women with systemic lupus erythematosus (SLE) have a higher risk of adverse pregnancy-related outcomes, including hypertensive disorders, maternal death, preterm birth, spontaneous abortion, and induced abortion, according to researchers.

Their study, “Adverse pregnancy outcomes in adolescents and young women with systemic lupus erythematosus: a national estimate,” appeared in the journal Pediatric Rheumatology.

SLE affects adolescents and young adult women of childbearing age. Both the disease and its treatments may have an impact on maternal and fetal outcomes. Studies with national SLE registries have reported a greater risk of preterm labor, limited fetal growth, hypertensive disorders, maternal death, and fetal death.

Among the risk factors for poor pregnancy outcomes in SLE women are active disease, high doses of glucocorticoids, renal involvement, and lower education levels. Research also showed a greater incidence of kidney involvement in adolescents compared to adults with SLE.

Like healthy teens, young SLE patients are at a greater risk of unintended pregnancy compared to older women. But studies are scarce on pregnancy incidence and outcomes in teens and young women with SLE.

The only study focusing on pregnancy risk in this group conducted in the last decade was conducted in Brazil and identified intravenous cyclophosphamide use at the start of pregnancy as the only risk factor for fetal loss. The limited sample size as well as the lack of comparison between those with and without SLE in the study warrants research with larger patient groups.

In this study, scientists used a U.S. national dataset, the 2000-2011 Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP), to calculate the prevalence of adverse pregnancy outcomes in SLE patients ages 14-21 at the time of delivery.

The study also evaluated differences in length of stay and total charges per hospitalization. Results from SLE patients were compared to those without the disease (controls).

A total of 8,791,391 pregnancies were identified, 4,002 of them in young women with SLE. After adjusting for age, race, insurance type, and median income based on patient ZIP code, the data revealed that SLE patients had increased rates of the hypertensive disorders pre-eclampsia/eclampsia, maternal death, preterm birth, spontaneous abortion, and induced abortion.

The findings are in accordance with prior results in adult SLE women, the investigators found.

An additional analysis showed that the increased risk was greatest for preterm birth, pre-eclampsia/eclampsia, and spontaneous abortion. Comparatively, the difference in risk for maternal death was not statistically significant.

Teens and young women with SLE also showed an increased median length of stay and higher total charges for hospitalization.

“This study demonstrated an increased risk of adverse pregnancy-related outcomes among adolescents and young women with SLE as compared to their peers without SLE, utilizing a large nationwide dataset,” the scientists wrote.

In 2011, the NIS captured 97 percent of the U.S. population hospital discharges from 46 states, which means the findings from that year can be generalized for nearly the entire U.S. population, the team wrote.

Among the study’s limitations, the researchers mentioned that the classification of SLE and adverse maternal pregnancy outcomes is subject to coding error and misclassification.

The researchers could not evaluate the impact of SLE duration, damage, and activity, as well as the effects of medications. Also, deliveries and abortions that didn’t take place in hospitals were not accounted for.

“This work provides practitioners with tangible estimates of risk for young women and adolescents that can be leveraged when discussing reproductive health and when counseling adolescents who become pregnant,” they added.