ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2533

A Comparison of Pregnancy Outcomes before and after Lupus Diagnosis

Megan E. B. Clowse1, Maria Dall'Era2, Jennifer M. Grossman3,4, Diane L. Kamen5, Jerry McGwin6, Robert Roubey7 and Jill P. Buyon8, 1Rheumatology & Immunology, Duke University, Durham, NC, 2University of California San Francisco School of Medicine, San Francisco, CA, 3Medicine, UCLA David Geffen School of Medicine, Division of Rheumatology, Los Angeles, CA, 4Rheumatology, UCLA, Los Angeles, CA, 5Medicine, Medical University of South Carolina, Charleston, SC, 6Deparment of Epidemiology, University Of Alabama at Birmingham, School of Public Health, Birmingham, AL, 7University of North Carolina, Chapel Hill, NC, 8Medicine, Division of Rheumatology, New York University School of Medicine, New York, NY

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Tuesday, November 10, 2015

Title: Reproductive Issues in Rheumatic Disorders: Basic and Clinical Aspects Poster Session

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The frequency of pregnancy complications, including
miscarriage, stillbirth, preeclampsia, and preterm birth varies between lupus
cohorts.  This analysis compares
pregnancy outcomes that occurred before and after the diagnosis of SLE.

Methods: We analyzed data from a registry of approximately 1700
patients with SLE from 17 lupus centers in the United States and Canada.  At study enrollment, all women reported the
outcomes of their prior pregnancies and, when known, the year of delivery.  The timing of onset for each ACR criteria was
obtained and the date of the accrual of the 4th criteria as the
formal diagnosis of SLE. All pregnancies with a reported date of completion and
in women with at least four ACR criteria at enrollment were included in this
analysis. Pregnancies were divided into two groups: 1) pregnancies completed
prior to the year of SLE diagnosis and 2) pregnancies delivered in the year of
or the years following SLE diagnosis. 
Descriptive statistics, t- and chi square tests were used to compare the
enrollment variables between the two groups. 
Generalized estimating equations were used to compare pregnancy outcomes
between the groups to accommodate for multiple pregnancies in some women.

Results:
A total of 2,277 pregnancies were
reported in 860 women. Of these pregnancies, 499 occurred after the diagnosis
of SLE, 1444 occurred before the diagnosis of SLE and 277 were unassigned due
to no reported date of pregnancy completion. Compared to pre-SLE pregnancies,
those after SLE diagnosis had a significantly lower risk of live birth and a
higher risk of spontaneous abortions/miscarriage (see table).  There was not a significant difference in the
risks of fetal demise/stillbirth or in elective termination.  Over a third of post-SLE pregnancies were low
birth weight and/or delivered preterm. 
The risk of preterm birth and delivering a low birth weight infant was
several-fold higher post-SLE than pre-SLE. 
While the pre-SLE risk of preeclampsia was similar to the general
population, it was over 2.5-fold higher in the post-SLE pregnancies.  The risk of preterm preeclampsia, a serious
condition for both mother and infant, was almost 6-fold higher post-SLE
diagnosis.  Of the cases of preeclampsia,
only 30.1% pre-SLE diagnosis were preterm, compared to 69.6% of those
post-SLE. 

Conclusion:   Compared to
pregnancies preceding the diagnosis of lupus, pregnancies following the
diagnosis of lupus had higher risks of spontaneous abortion, preterm birth, low
birth weight, preeclampsia, and preterm preeclampsia. 

 Table: Pregnancies before and
after SLE diagnosis

Pregnancy Outcomes

Pregnancies after SLE

Pregnancies prior to SLE

Relative Risk

(95% CI)

p-value

Total pregnancies

499

1444

Live birth

316 (63.3%)

1054 (70.4)

0.87 (0.81-0.94)

<0.001

Fetal demise

13 (2.8%)

40 (2.8%)

0.89 (0.44-1.83)

0.77

Spontaneous abortions

99 (19.8%)

193 (13.4%)

1.48 (1.13-1.87)

<0.01

Termination

71 (14.2%)

157 (10.9)

1.29 (0.95-1.74)

0.09

Of LIVE BIRTHS:

(with reported outcomes)

(n=316)

(n=1054)

Low birth weight (<2500g)

108 (34.2%)

134 (12.7%)

 2.69 (2.08-3.47)

<0.0001

Extreme low birth weight (<1500g)

29 (9.2%)

20 (1.9%)

4.84 (2.77-8.44)

<0.001

Preterm birth (<37 weeks)

123 (38.9%)

129 (12.2%)

3.18 (2.46-4.11)

<0.0001

Extreme preterm birth (<30 weeks)

 24 (7.6%)

 24 (2.2%)

 3.45 (1.72-6.45)

<0.01

Neonatal lupus

8 (2.5%)

5 (0.5%)

5.34 (1.24-23.01)

0.03

Preeclampsia

56 (17.7%)

71 (6.7%)

2.58 (1.78-3.74)

<0.0001

Preterm & preeclampsia

39 (12.3%)

22 (2.1%)

5.91 (3.47-10.08)

<0.0001
Disclosure: M. E. B. Clowse, None; M. Dall'Era, None; J. M. Grossman, None; D. L. Kamen, None; J. McGwin, None; R. Roubey, None; J. P. Buyon, None.

To cite this abstract in AMA style:

Clowse MEB, Dall'Era M, Grossman JM, Kamen DL, McGwin J, Roubey R, Buyon JP. A Comparison of Pregnancy Outcomes before and after Lupus Diagnosis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/a-comparison-of-pregnancy-outcomes-before-and-after-lupus-diagnosis/. Accessed .

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