Session Information
Date: Monday, October 22, 2018
Title: 4M087 ACR Abstract: Reproductive Issues in Rheumatic Disorders (1852–1857)
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Because aspirin reduces the risk of preeclampsia in high-risk pregnancies by more than half, best practice guidelines recommend that aspirin be initiated in pregnant women with ≥1 high-risk factors for preeclampsia, including SLE. Our objective was to assess the prevalence of aspirin use in SLE pregnancies within a multi-national inception cohort, and compare aspirin use among those with and without additional preeclampsia risk factors.
Methods: Premenopausal women aged 18-45 were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) Registry (2000-2017) within 15 months of SLE diagnosis. Study visits with a current pregnancy were assessed for aspirin use and preeclampsia risk factors (hypertension, renal disease, diabetes, nulliparity, BMI≥35, age>40). Aspirin use was compared among those with and without such risk factors, as well as disease-specific risk factors (e.g. antiphospholipid antibodies [+aPL]), and over time.
Results: We identified 300 women with 475 pregnancies. Half (51%) had ≥1 traditional preeclampsia risk factors (in addition to SLE), and a third (33%) had +aPL. We observed aspirin use in 25% of pregnancies (95%CI 22,29), which did not differ among pregnancies with and without ≥1 traditional risk factor [25% (95%CI 20,31) versus 26% (95%CI 21,32)]. Aspirin use was higher among those with +aPL [38% (95%CI 24,55)] versus those without [23% (95%CI 15,34)], and was higher in whites [32% (95%CI 26,39)] compared with black women [10% (95%CI 5,18)].Regional variability was observed in aspirin use (12-37%). We could not establish a trend of increasing aspirin use over time.
Conclusion: In this multi-centre analysis of SLE pregnancies, we observed that most women were not on aspirin and that half had additional preeclampsia risk factors. It is possible that aspirin was introduced at/or following the study visit when the pregnancy was documented, highlighting the importance of the rheumatologist in reviewing aspirin use and initiating it, if not already done, in pregnant SLE women. Our findings suggest black SLE women as a potentially vulnerable group during pregnancy, having the lowest prevalence of aspirin use.
Table 1: Demographic and disease characteristics according to aspirin use
|
Characteristic |
All pregnant visits (n=475) |
Pregnant visits with aspirin (n=121) |
Pregnant visits without aspirin (n=354) |
|
Patient characteristic |
|||
|
Age, mean (SD) |
31.0 (4.9) |
30.5 (4.6) |
31.2 (5.0) |
|
Ethnicity, n (%) Asian Native North American Black Caucasian Hispanic Indian subcontinent Other |
66 (14) 7 (2) 88 (19) 205 (43) 62 (13) 25 (5) 22 (5) |
7 (11) 6 (86) 9 (10) 67 (33) 20 (32) 8 (30) 4 (18) |
59 (89) 1 (14) 79 (90) 138 (67) 42 (68) 17 (68) 18 (81) |
|
Country, n (%) Canada United States Mexico Europe South Korea |
121 (25) 105 (22) 52 (11) 146 (31) 51 (11) |
27 (22) 20 (19) 19 (37) 49 (34) 6 (12) |
94 (77) 85 (81) 33 (63) 97 (66) 45 (88) |
|
Years of education prior to college or university, mean (SD) |
11.6 (2.0) |
11.1 (2.1) |
11.8 (2.0) |
|
Years of post-secondary education, mean (SD) |
2.6 (2.7) |
2.4 (2.7) |
2.7 (2.7) |
|
Any post-secondary education, n (%) |
310/452 (69) |
69/310 (22) |
241/310 (77) |
|
BMI, mean (SD) |
25.8 (5.9) |
26.3 (5.2) |
25.6 (6.1) |
|
Obstetrical history |
|||
|
Parity, mean (SD) |
1.1 (1.0) |
1.1 (1.0) |
1.2 (1.0) |
|
Nulliparous, n (%) |
134/461 (30) |
37/134 (28) |
97/134 (72) |
|
Previous fetal loss <24 weeks, n (%) |
84/456 (18) |
22/84 (26) |
62/84 (74) |
|
SLE characteristics |
|||
|
Disease duration, mean (SD) |
5.6 (3.3) |
5.6 (3.3) |
5.6 (3.3) |
|
SLEDAI, mean (SD) |
3.3 (3.8) |
3.0 (3.6) |
3.4 (3.9) |
|
SLICC damage score, mean (SD) |
0.5 (1.0) |
0.6 (1.0) |
0.5 (1.0) |
|
Any positive aPL n (%) |
34/104 (33) |
13/34 (38) |
21/34 (62) |
|
LAC n (%) |
19/104 (18) |
6/19 (32) |
13/19 (68) |
|
ACL n (%) |
12/104 (12) |
3/12 (25) |
9/12 (75) |
|
GP1 IgG* n (%) |
18/104 (17) |
9/18 (50) |
9/18 (50) |
|
History of nephritis, n (%) |
53 (11) |
11/53 (21) |
42/53 (79) |
|
Co-morbidities |
|||
|
Any renal disease†, n (%) |
83 (17) |
17/83 (20) |
66/83 (80) |
|
CKD (eGFR <=90) n (%) |
43/459 (9) |
6/43 (14) |
37/43 (86) |
|
CKD stage 3 or less (eGFR <=60) n (%) |
11/459 (2) |
5/11 (45) |
6/11 (55) |
|
Hypertension, n(%) |
79 (17) |
24/79 (30) |
55/79 (70) |
|
Anticoagulant use, n(%) |
28 (6) |
12 (43) |
15 (54) |
|
SD, standard deviation; BMI, Body Mass Index; CKD, Chronic kidney disease; eGFR, estimated glomerular filtration rate; PE, preeclampsia; aPL, antiphospholipid antibody; LAC, lupus anticoagulant; ACL, anti-cardiolipin antibody; GPI, anti-B2-glycoprotein-1; SLEDAI, Systemic Lupus Erythematosus Disease Activity Index; SDI, Systemic Lupus International Collaborating Clinics * no positive GP1 IgM identified in any group † including CKD, nephritis, nephrotic syndrome within the last year |
|||
Table 2: Prevalence of aspirin use according to preeclampsia risk factors
|
Risk factor |
Prevalence of aspirin use |
|
|
With risk factor |
Without risk factor |
|
|
Age >40 |
2/14 (14, 4-40) |
119/461 (26, 22-30) |
|
BMI ≥35 |
8/33 (24, 13-41) |
113/442 (26, 22-30) |
|
Nulliparous |
37/134 (28, 21-36) |
79/327 (24, 20-29) |
|
Any renal disease |
17/83 (20, 13-30) |
104/392 (27, 22-31) |
|
CKD stage 3 or worse |
5/11 (45, 21-72) |
112/448 (25, 21-29) |
|
Nephritis |
11/53 (21, 12-23) |
109/417 (26, 22,30) |
|
Hypertension |
24/79 (30, 21-41) |
97/396 (24, 21-29) |
|
Diabetes |
0/2 (0, 0-1) |
121/473 (26, 22-30) |
|
≥1 traditional PE risk factor* |
58/234 (25, 20-31) |
63/241 (26, 21-32) |
|
aPL + |
13/34 (38, 24-55) |
16/70 (23, 15-34) |
|
Anticoagulant use |
12/28 (43, 27-61) |
109/447 (24, 21-29) |
|
BMI, Body Mass Index; CKD, Chronic kidney disease; PE, preeclampsia; aPL, antiphospholipid antibody; LAC, lupus anticoagulant * Any of Age >40, BMI≥35, Nulliparity, Any renal disease, Hypertension, or Diabetes |
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To cite this abstract in AMA style:
Mendel A, Bernatsky S, Vinet E. Low Aspirin Use and High Prevalence of Preeclampsia Risk Factors Among Pregnant Women in a Multi-National SLE Inception Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/low-aspirin-use-and-high-prevalence-of-preeclampsia-risk-factors-among-pregnant-women-in-a-multi-national-sle-inception-cohort/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-aspirin-use-and-high-prevalence-of-preeclampsia-risk-factors-among-pregnant-women-in-a-multi-national-sle-inception-cohort/