Background/Purpose: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that predominantly affects women of childbearing age. Pregnant women with SLE have higher rates of adverse maternal and fetal outcomes than the general population. There is limited research on the risk of infection during pregnancy among women with SLE. This study aims to contribute to a better understanding of the incidence of infection in this population, the factors associated with increased infection risk, and compare the risk of infection among pregnant women with and without SLE.

Methods: Medical records from Tawam Hospital were reviewed retrospectively to identify patients with SLE (diagnosed based on ACR criteria) and pregnancy history. We collected data on demographics, clinical variables, and maternal (including infection). We randomly selected a one-to-one age-matched healthy control group and collected their pregnancy history. In cases of infection, we recorded the number and type of infection. We compared the infection odds ratios between pregnant women with and without SLE. Using multivariate analysis, we examined factors associated with infection in pregnant women with SLE.

Results: The outcomes of 78 pregnancies in 39 women with SLE and 107 pregnancies in 39 without SLE were analyzed. The mean age of both groups was similar (P=0.5). Infection episodes occurred in 55.8% of SLE pregnancies and 27% of non-SLE pregnancies (odds ratio 3.2, 95%CI 1.7-5.9). Among SLE pregnancies, we have a total of 98 infection episodes. In 51% of the SLE infections, patients received antibiotics. Most common infection was respiratory infection (43.9%), genitourinary (31.6%), skin and soft-tissue (9.2%), gastrointestinal (9.2%), and others (6.1%). In multivariate analysis, we examined demographic, SLE disease activity, and symptoms for association with increased risk of infection. We found no factors to increase the risk of infection among SLE pregnancies. However, hydroxychloroquine was protective against infection (table 1).

Table1. Multivariable analysis for factors associated with the risk of infection requiring antibiotics.

Conclusion: Pregnant women with SLE have a significantly higher risk of infection compared to their non-SLE counterparts. The most common infection in SLE pregnancies was respiratory. No particular factors were identified to increase the infection risk among the SLE pregnancies. Interestingly, hydroxychloroquine use during pregnancy was found to be protective against infection. This finding highlights the importance of medication management in mitigating infection risks for pregnant women with SLE. However, further research is warranted to investigate the mechanisms involved in the increased risk of infection in pregnancies among women with SLE.

« Back to ACR Convergence 2023

ACR Meeting Abstracts - https://acrabstracts.org/abstract/infection-vulnerability-in-pregnant-women-with-and-without-systemic-lupus-erythematosus/