Background/Purpose: Increased insulin resistance is pivotal in the development of gestational diabetes mellitus (GDM). Women with SLE may be at higher risk of GDM due to their increased risk of insulin resistance and use of glucocorticoids. In contrast, use of hydroxychloroquine may lower the risk of GDM. This study investigated the risk of GDM in women with SLE compared to women from the general population.

Methods: Women with SLE and comparators without SLE from the general population were identified from the Swedish Lupus Linkage (SLINK) cohort. Briefly, SLINK includes all individuals with SLE identified in the Swedish National Patient Register (NPR) and 5 randomly selected individuals without SLE matched on sex, birth year, calendar time, and county of residence between 1964-2013. SLE (International Classification of Diseases (ICD) 10: M32) was defined by ≥2 visits in the NPR and Medical Birth Register (MBR) with ≥1 of these visits preceding pregnancy. Women in the study population with singleton births in the MBR (Nov 2006-2016) were included. GDM (ICD 10: O24.4) was defined by ≥1 visit in the NPR and MBR during pregnancy. Glucocorticoid and hydroxychloroquine dispensations 6 months before and during pregnancy, and anti-diabetic drug dispensations at any time before and during pregnancy were collected from the Prescribed Drug Register. Women with drug-induced SLE (ICD 10: M32.0), diabetes mellitus (ICD 10: E10-E11, H36.0, O24 excluding O24.4) or filling anti-diabetic drugs (Anatomical Therapeutic Chemical (ACT) codes: A10A, A10B) at any time before pregnancy or during the first trimester were excluded. Risk ratio (RR) of GDM associated with SLE comparing SLE pregnancies with non-SLE pregnancies was estimated for first births only and all births using a Modified Poisson Regression model adjusted for age, year of birth and previous GDM.

Results: We identified 695 pregnancies among 502 women with SLE and 4,637 pregnancies among 3,243 women without SLE. Of these, 18 (2.6%) pregnancies among 14 women with SLE and 58 (1.3%) pregnancies among 44 women without SLE were diagnosed with GDM. Among GDM pregnancies, mean age at delivery was higher in women with SLE (35 years) than in women without SLE (33 years). The adjusted RR of GDM associated with SLE was 1.2 (95% Confidence Interval (CI) 0.5-2.9) for first births and 1.8 (95% CI 1.2-2.8) for all births. The proportion of SLE pregnancies without any glucocorticoid or hydroxychloroquine dispensation before or during pregnancy were similar between those with GDM (61.1% or 61.1%, respectively) and those without GDM (55.5% or 58.5%, respectively). In 5 out of 18 SLE pregnancies with GDM (27.7%) and in 207 out of 677 SLE pregnancies without GDM (30.6%), women received ≥1 glucocorticoid dispensation both before and during pregnancy. In 6 SLE pregnancies with GDM (33.3%) and in 184 SLE pregnancies without GDM (27.2%), women received ≥1 hydroxychloroquine dispensation both before and during pregnancy.

Conclusion: Although the number of SLE pregnancies with GDM (2.6%) were small, the RR of GDM was almost 2 times higher in pregnancies with SLE than in pregnancies without SLE. Neither glucocorticoids nor hydroxychloroquine differed by the GDM outcome.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gestational-diabetes-mellitus-in-pregnant-women-with-systemic-lupus-erythematosus/