Background/Purpose: Veterans who utilize Department of Veterans Affairs (VA) maternity benefits, nearly half (42%) of whom represent racial or ethnic minority groups, have a high prevalence of chronic medical conditions and social risks that may elevate their risk of pregnancy-related complications and adverse pregnancy outcomes, including severe maternal morbidity (SMM). Research suggests that people with rheumatic diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are at increased risk of adverse pregnancy outcomes; however, little is known about pregnancy outcomes among Veterans with RA or SLE.

Methods: We conducted a retrospective cohort study using VA national administrative data from Veterans ages 18-45 with at least one pregnancy between October 2009 – September 2019 and a VA primary care visit within one year prior to pregnancy. Pre-pregnancy medical and mental health comorbidities, including RA and SLE, were identified by the presence of relevant ICD-9 and/or ICD-10 codes in the 2 years prior to the start of pregnancy. We identified SMM during pregnancy and up to 42 days after pregnancy using ICD-9 and ICD-10 codes for the Center for Disease Control and Prevention’s 21 indicators for SMM during delivery hospitalization.

Results: Among 29,713 Veterans with a recorded pregnancy during our study timeframe, 0.3% (n=92) had a documented history (i.e., ≥2 relevant diagnosis codes ≥ 30 days apart in the 2 years prior to pregnancy) of RA and 0.4% (n=113) had a documented history of SLE.  Nearly one-third (31.4%) of Veterans with RA and 50.9% of Veterans with SLE were Black and over 60% of Veterans with RA or SLE were younger than age 34. Thirty-seven percent of pregnancies among Veterans with SLE and 29.1% of pregnancies among Veterans with RA were ectopic or resulted in spontaneous abortion, compared to 25% of pregnancies in the overall sample. Over 10% of pregnancies among Veterans with SLE and 5% of pregnancies with RA experienced any SMM event during pregnancy or within 42 days of the end of pregnancy, compared to 3% of pregnancies in the overall sample.

Conclusion: Our sample likely does not represent outcomes of all pregnancies among Veterans with SLE or RA, as upon confirmation of pregnancy, all Veterans receive prenatal and obstetric care through the community care system. However, our data suggest that Veterans with SLE may be at higher risk for severe maternal morbidity than other Veterans. As the largest integrated healthcare system in the United States and with existing robust integrated care delivery models, VA may be uniquely poised to provide perinatal rheumatology care that improves pre-pregnancy health and pregnancy outcomes among people with rheumatic diseases.

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/describing-maternal-outcomes-among-veterans-with-a-history-of-systemic-lupus-erythematosus-and-rheumatoid-arthritis/