Background/Purpose: Adverse pregnancy outcomes have been associated with increased cardiovascular disease in healthy women.  We hypothesized that women with SLE and a history of adverse pregnancy outcomes would have a higher rate of cardiovascular events.

Methods: Prior pregnancy outcomes, cardiovascular risk factors and events were collected in 2010 and 2011 through a longitudinal lupus registry.  Study participants were enrolled at 17 lupus centers across North America.  At enrollment, each patient reported her prior pregnancies and outcomes, including live birth, week gestation (<37 weeks indicated preterm delivery), and preeclampsia.  Cardiovascular events were recorded in the SLICC-Damage Index at study entry and included prior angina or CABG, myocardial infarction, or cerebrovascular accident.  Prior medical history, including a diagnosis of hypertension, diabetes, and hypercholesterolemia, current medications, and prior and current laboratory values were also reported.  Univariate and multivariate analyses compared the frequency of pregnancy morbidity (a pregnancy loss, a preterm delivery, or a pregnancy with preeclampsia) among women with and without cardiovascular events.  Nulliparous women were excluded from the analysis.

Results: Data are available for 602 women, of whom 316 (52.5%) had at least one prior pregnancy morbidity.  The average age of SLE diagnosis and LCTC enrollment was lower for women with a pregnancy morbidity (31.2 years and 43.8 years, respectively) compared to women without a pregnancy morbidity (34..3  and 46.6 years, p<0.01).  Women with a prior pregnancy morbidity were more likely to have antiphospholipid syndrome (11.1% vs 4.2%, p=0.008).  The systolic blood pressure measured at enrollment, the frequency of hypertension, and the use of antihypertensive medications at LCTC enrollment were all significantly higher among women with a history of pregnancy morbidity.   In contrast, the frequency of diabetes mellitus, use of anti-cholesterol medications, and hypercholesterolemia at enrollment were not significantly different between the pregnancy groups.   Despite the significant increase in hypertension, the frequency of overall cardiovascular events was not significantly different between the groups: 8.23% with pregnancy morbidity vs 6.64% without pregnancy morbidity, p=0.4.  A multivariate analysis demonstrated that cardiovascular events were associated with older age at LCTC enrollment, hypertension, and APS, but not race, number of pregnancies, or pregnancy morbidity.

Conclusion: Prior pregnancy morbidity is not significantly associated with cardiovascular events in this large multi-center multiethnic/racial cohort of lupus patients.  This may be due to the relative young age of the cohort with the average age less than 50 years at entry. The association of pregnancy morbidity with hypertension, however, suggests that these women may be a higher risk for future cardiovascular events.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-between-prior-pregnancy-morbidity-and-cardiovascular-events-in-women-with-systemic-lupus-erythematosus/