Background/Purpose: SLE mothers are known to have higher rates of pre-term birth and low birth weight compared to women in the general population. We evaluated birth outcomes in women with systemic lupus erythematosus (SLE) before and after developing disease on a population level.

Methods: The Georgia Lupus Registry (GLR) is a population-based registry of SLE patients living in Atlanta, GA from 2002-04. Patients were validated by meeting ³4 ACR criteria or 3 ACR criteria with a final diagnosis of SLE by a board certified rheumatologist and were matched to the Georgia Birth Records database (1994-2013), which provided various information on the births. Births were dichotomized into 2 periods, one before lupus activity began (ÒPreLupusÓ) and the other after (ÒPostLupusÓ), and compared. In order to take into account subclinical and/or significant immunologic activity just prior to being diagnosed with SLE, the time point separating the periods was made to be 1 year prior to the physician diagnosis date.

Results: 345 total patients were incident in 2002-04. 87% were women and 73% were black. A total of 77 births in the PreLupus period and 247 in the PostLupus period were observed. Among incident SLE mothers, there were significant increases in pre-term births from 18.7% in the PreLupus period to 44.8% in the PostLupus period, number of low birth weight births from 20.8% to 55.2%, and number of births with low APGAR scores from 6.2% to 41.4%. There was a trend to increasing number of previous terminations from 25% to 33.3%. 1,446 patients were prevalent in 2002. 89.9% were women and 75.7% were black. Only low birth weight changed significantly from 14.7% in the PreLupus period to 30.1% in the PostLupus Period. There was generally good reported prenatal care and frequency of care and little, if any, reported alcohol or tobacco use during pregnancy on the birth certificates.  

Conclusion: This is the first population-based description of birth outcomes in SLE in the US. The ratio of births to mothers in the PreLupus compared to the PostLupus periods predictably goes down but not dramatically, demonstrating reproductive capacity and resolve in these patients. Our study supports previous observations of more frequent rates of adverse birth outcomes in those with SLE. Pre-term birth, low birth weight, and low APGAR scores are significantly more frequent, particularly in incident SLE patients. More study is needed to better understand the impact of SLE on birth outcomes in order to guide patients interested in reproduction.