Background/Purpose: Individuals with SLE are at increased risk for pregnancy complications such as preeclampsia and preterm delivery. As SLE is commonly diagnosed and active during the childbearing years—and more individuals are pursuing pregnancy due to improved management—there is a growing need to better understand pregnancy outcomes in this population. To address this, we describe pregnancy characteristics and outcomes among individuals enrolled in Medicaid, a publicly funded health insurance program available nationwide.

Methods: Using data from Medicaid T‑MSIS Analytic Files (TAF), we identified all pregnancies for patients with SLE from 2014 to 2019. SLE was defined as ≥2 ICD coded outpatient visits occurring less than 30 days apart or ≥1 ICD coded inpatient visit (ICD9: 710.0, ICD10: M32.1X, M32.8, M32.9) occurring before or during pregnancy. We described demographic factors (age, race and ethnicity, and income relative to federal poverty level) and pregnancy characteristics (parity, delivery type, complications, comorbidities occurring during and before pregnancy, and pregnancy outcomes). Additionally, we stratified the pregnancy outcomes by race.

Results: This diverse cohort consisted of 9391 pregnancies among 8201 individuals with SLE , with 2% identifying as Asian, 29% as Black, 17% as Hispanic, and 32% as white. Forty-four percent were below the federal poverty level. Most pregnancy were livebirths (93%). Approximately 16% of pregnancies were complicated by preeclampsia and 18% resulted in preterm delivery. (Table 1). When stratified by race, Black individuals had the highest prevalence of preeclampsia (19%) and preterm delivery (22%). (Table 2)

Conclusion: Pregnancies among patients with SLE had a high frequency of preeclampsia and preterm delivery compared to estimates in the general population (3-7% preeclampsia and 10% preterm). Black individuals had the highest prevalence of complications. These findings offer contemporary, national estimates of pregnancy complications and outcomes among publicly-insured individuals with SLE, highlighting variations by parity and comorbidity burden, and provide patients and providers with further data to inform pregnancy planning and risk counseling.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-and-comorbidities-among-individuals-with-systemic-lupus-erythematosus-a-nationwide-study-using-publicly-funded-health-insurance-claims-data/