Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Systemic lupus erythematosus (SLE) typically presents in women of childbearing age. As such, it is important to understand how the clinical characteristics of SLE affect pregnancy outcomes. This research question is being assessed in a secondary analysis of the Hopkins Lupus Pregnancy Cohort.
Methods
Data from the Hopkins Lupus Pregnancy Cohort for pregnancies occurring on or after 01 Jan 2000. Maternal clinical characteristics in the 6 months prior to or during pregnancy that were analyzed included co-morbidities (pregnancy-induced hypertension, placental abruption, pre-eclampsia, gestational diabetes, proteinuria, hypertension and thrombocytopenia), concomitant medications (corticosteroids, other immunosuppressants, NSAIDs, anti-malarials and heparin) and lab tests (low C3/C4, anticardiolipin antibodies and anti-dsDNA+). We evaluated whether maternal clinical characteristics were associated with low birth weight (LBW; <2500 g) pregnancy outcome for live births. Fischer exact p-values were calculated in this analysis (WEUKBRE5887 & WEUKBRE4566; 114256).
Results
In this analysis, there were 213 pregnancies in 190 women (median age: 30 years; median SLE duration: 5.5 years; 51% white, 37% black, 12% other). There were 16 (7.5%) spontaneous miscarriages, 6 (2.8%) stillbirths and 188 (88.3%) live births (median gestational age: 38 weeks). The outcome was unknown in three of the pregnancies. Of the live births, 38 (20.2%) were preterm, 15 (8.0%) were small for gestational age (SGA; defined as weight <10th percentile for gestational age) and 41 (21.8%) were LBW. Compared to mothers of infants with normal birth weight (Table 1), mothers of infants with LBW had a greater frequency of hypertension (34.1% vs. 17.0%; p=0.01), proteinuria (12.2% vs. 3.4%; p=0.03) and higher dose steroid use (≥7.5 mg/day) in the 6 months prior to or during pregnancy (63.4% vs. 47.6%; p=0.03).
|
Table 1. Association of maternal clinical characteristics1 and low birth weight pregnancy outcome in the Hopkins Lupus Pregnancy Cohort |
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|
|
Total Live Births |
Normal Birth Weight (≥2500g) |
Low Birth Weight (<2500g) |
Fischer Exact p-value |
|
|
n=188 |
n=147 |
n=41 |
|
|
|
n (%) |
n (%) |
n (%) |
|
|
Co-Morbidities |
|
|
|
|
|
Hypertension |
39 (20.7) |
25 (17.0) |
14 (34.1) |
0.01 |
|
Pregnancy-induced hypertension |
7 (3.7) |
5 (3.4) |
2 (4.9) |
0.3 |
|
Placental abruption |
1 (0.5) |
0 (0.0) |
1 (2.4) |
0.2 |
|
Pre-eclampsia |
16 (8.5) |
6 (4.1) |
10 (24.4) |
<0.0001 |
|
Proteinuria |
10 (5.3) |
5 (3.4) |
5 (12.2) |
0.03 |
|
Gestational diabetes |
2 (1.1) |
2 (1.4) |
0 (0.0) |
0.6 |
|
Thrombocytopenia |
12 (6.4) |
8 (5.4) |
4 (9.8) |
0.2 |
|
Medications2 |
|
|
|
|
|
Corticosteroids3 |
|
|
|
|
|
≥7.5 mg/day |
96 (51.1) |
70 (47.6) |
26 (63.4) |
0.03 |
|
<7.5 mg/day |
91 (48.4) |
76 (51.7) |
15 (36.6) |
0.03 |
|
Missing |
1 (0.5) |
1 (0.7) |
0 (0.0) |
— |
|
Other immuno-suppressants |
56 (29.8) |
41 (27.9) |
15 (36.6) |
0.08 |
|
NSAIDs4 |
66 (35.1) |
55 (37.4) |
11 (26.8) |
0.07 |
|
Antimalarials |
154 (81.9) |
121 (82.3) |
33 (80.5) |
0.2 |
|
Heparin |
39 (20.7) |
31 (21.1) |
8 (19.5) |
0.2 |
|
Lab Values |
|
|
|
|
|
Low C3/C4 |
110 (58.5) |
84 (57.1) |
26 (63.4) |
0.1 |
|
Anticardiolipin antibodies |
14 (7.4) |
11 (7.5) |
3 (7.3) |
0.3 |
|
IgG |
6 (3.2) |
5 (3.4) |
1 (2.4) |
0.4 |
|
IgM |
9 (4.8) |
7 (4.8) |
2 (4.9) |
0.3 |
|
IgA |
3 (1.6) |
2 (1.4) |
1 (2.4) |
0.4 |
|
Anti-dsDNA+ |
100 (53.2) |
78 (53.1) |
22 (53.7) |
0.1 |
|
1Observation period defined as the 6 months prior to and/or during pregnancy 2Medication use ever in the observation period 3Corticosteroid use categories are mutually exclusive. Patients with higher dose (≥7.5 mg/day) ever during the observation period were not included in the low dose (<7.5/mg day) category. 4NSAIDS: nonsteroidal anti-inflammatory drugs |
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Conclusion
In this analysis, certain maternal clinical characteristics were associated with LBW in infants born to mothers with SLE. Although a greater frequency of higher dose steroid use was observed in mothers of infants with low birth weight, it is possible that treatment with higher dose steroids (≥7.5 mg/day) was a proxy for more active SLE in the 6 months prior to or during pregnancy, rather high dose steroid use having a direct effect on low birth weight. Data from this analysis will complement planned analyses for the Belimumab Pregnancy Registry, an ongoing international, prospective cohort study of women exposed to commercially-supplied belimumab within 4 months prior to and/or during pregnancy (WEUKBRE6076; clinicaltrials.gov ID NCT01532310; 114256).
Disclosure:
M. Petri,
GlaxoSmithKline,
5;
A. Eudy,
GlaxoSmithKline,
3;
M. Powell,
GlaxoSmithKline,
1,
GlaxoSmithKline,
3;
G. Giguere,
GlaxoSmithKline,
3;
Q. Fu,
GlaxoSmithKline,
1,
GlaxoSmithKline,
3;
D. Hill,
GlaxoSmithKline,
1,
GlaxoSmithKline,
3.
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