Session Information
Date: Monday, November 9, 2015
Title: Reproductive Issues in Rheumatic Disorders: Basic and Clinical Aspects
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Both lupus and pregnancy have significant
racial disparities, with black women experiencing higher rates of complication
compared to other race and ethnic groups.
No large studies have focused on the impact of race/ethnicity on
pregnancy outcomes among women with lupus.
Methods: Using the Nationwide Inpatient Sample (NIS)
for years 2008-2010, pregnancy delivery discharges were identified and pregnancy
outcomes were compared for women with lupus by maternal race/ethnicity. Women with lupus were identified using ICD-9
code 710.0. Adjusted odds ratios were calculated
for various pregnancy outcomes comparing black or Hispanic women with lupus to
white women with lupus.
Results: Between 2008 and 2010, there were 13,553
delivery discharges to women with lupus and 12,510,565 delivery discharges to
women without lupus. Pregnant white
women with lupus were, on average, 2 years older than pregnant black and
Hispanic women with lupus (see Table).
The cost for delivery among women with lupus was $2000-5000 higher for
Hispanic and black women compared to white women. The
rate of chronic hypertension was high in lupus pregnancies, but highest among
black women (19.4%, OR 2.89) and Hispanic women (11.0%, OR 1.48) compared to
white women (7.7%). Chronic renal
failure was uncommon in pregnancy, but noted in 3.7% of black lupus pregnancies
(OR 3.47). Thrombophilia, including antiphospholipid syndrome, was only noted in 4.9-6.7% of
pregnancies and the rates were not different between
white, black, and Hispanic lupus pregnancies.
The rate of pregnancy
complication was high among lupus pregnancies.
Over 40% of pregnancies to mothers of all races delivered via cesarean. Preterm labor occurred in 14-25% of
pregnancies. Preeclampsia occurred in
almost 20% of black and Hispanic pregnancies.
After adjustment for predictors of pregnancy outcomes and racial
differences in non-lupus pregnancy, black and Hispanic women with lupus had
higher odds of acute renal failure, pneumonia, need for transfusion, preeclampsia,
preterm labor and fetal growth restriction than white women with lupus.
Conclusion: Black and Hispanic women with lupus have
disproportionately poor pregnancy outcomes compared to white women with lupus. These disparities are larger than expected in
the general population. While this study
is not designed to determine causation, we postulate that increased levels of
lupus activity and damage among black and Hispanic women may be in part to
blame. Additional sources of disparity
may include differences in access to quality care and prescribed medications. This study suggests that identifying the key
causes for these differences and targeting interventions to the women of
greatest need is an essential next-step.
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Table: The rates of medical and obstetric complications for white, black, and Hispanic women with lupus. The p-values are derived from multivariate logistic regression model that included variables that impact pregnancy outcome, including age, insurance status, thrombophilia, anemia, thrombocytopenia, drug use, alcohol use, tobacco use, chronic hypertension, chronic renal failure, diabetes, thyroid disorders, asthma, history of MI, multiple gestation, mode of delivery, and placenta previa. |
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Systemic Lupus Erythematosus
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p-value Black vs. White
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p-value Hispanic vs. White
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White n=5755
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Black n=2762
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Hispanic n=2088
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Maternal age, yrs
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30.3 ± 12.5 |
28.3 ± 13.4 |
28.0 ± 13.6 |
p<0.0001 |
p<0.0001 |
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Total charges, $
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$12,289 |
$14,649
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$17,453
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p<0.0001 |
p<0.0001 |
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Medical Complications in Pregnancy:
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Acute renal failure n (%)
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16 (0.28%) |
51 (1.8%) |
49 (2.3%) |
3.60 (1.91, 6.75) <0.0001 |
11.41 (6.05, 21.51) <0.0001 |
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Pneumonia
|
15 (0.26%) |
36 (1.3%) |
28 (1.3%) |
3.24 (1.76, 5.94) <0.0001 |
4.81 (2.60, 9.25) <0.0001 |
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Transfusion
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134 (2.3%) |
151 (5.5%) |
106 (5.1%) |
1.30 (1.01, 1.68) <0.0001 |
1.52 (1.15, 2.02) <0.0001 |
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Gestational diabetes
|
346 (6.0%) |
75 (2.7%) |
124 (5.9%) |
0.42 (0.33, 0.55) <0.0001 |
1.05 (0.84, 1.30) 0.86 |
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Obstetrical Complications:
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Preeclampsia, eclampia, gestational HTN
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780 (13.5%) |
525 (19.0%) |
412 (19.7%) |
1.16 (1.02, 1.32) <0.0001 |
1.44 (1.26, 1.65) <0.0001 |
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Preterm labor
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823 (14.3%) |
682 (24.7%) |
430 (20.6%) |
1.59 (1.41, 1.79) <0.0001 |
1.51 (1.32, 1.73) <0.0001 |
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Fetal growth restriction
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317 (5.5%) |
270 (9.8%) |
182 (8.7%) |
1.50 (1.26, 1.79) <0.0001 |
1.60 (1.32, 1.94) <0.0001 |
To cite this abstract in AMA style:
Clowse MEB, Grotegut C. Racial Disparities in Lupus Pregnancy [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/racial-disparities-in-lupus-pregnancy/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-disparities-in-lupus-pregnancy/