The Role of Race/Ethnicity and SES in Adverse Pregnancy Outcome in SLE and Apl

Sancia Ferguson¹, Elianna Kaplowitz², Laura Trupin³, Edward H. Yelin⁴, Patricia P. Katz^3,5 and Jane E. Salmon⁶, ¹Medicine/Rheumatology, University of California - San Francisco, San Francisco, CA, ²Hospital for Special Surgery, New York, NY, ³Medicine/Rheumatology, University of California San Francisco, San Francisco, CA, ⁴Medicine/Rheumatology, UC San Francisco, San Francisco, CA, ⁵Arthritis Research Group, University of California San Francisco, San Francisco, CA, ⁶Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: APL, pregnancy, race/ethnicity and socioeconomic status, SLE

Session Information

Date: Tuesday, November 10, 2015

Session Title: Reproductive Issues in Rheumatic Disorders: Basic and Clinical Aspects Poster Session

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Women with Systemic Lupus Erythematosus (SLE) and Anti-Phospholipid Antibodies (aPL) have pregnancies with higher rates of preterm labor, preeclampsia, and fetal loss than healthy women. While 80% of pregnancies in SLE patients with quiescent disease are uncomplicated by adverse pregnancy outcomes (APOs), limited data exist on differences in pregnancy outcomes by race/ethnicity. In this study we examined rates of APOs according to race/ethnicity among women with SLE with and without aPL and, if racial/ethnic differences in APO existed, whether socioeconomic status (SES) accounted for those differences

Methods: Analyses use data from the PROMISSE study, a multicenter, prospective observational study (2003 – 2014) of pregnant women 18 – 45 years with SLE and aPL. Subjects with SLE were enrolled by 12 weeks and subjects with aPL by 18 weeks at 9 U.S. and 1 Canadian site. Women with blood pressures of >140/90, taking prednisone ≥ 20 mg daily, or with active renal disease (> 1 gram on 24 hour urinalysis or spot, RBC casts, Cr >1.2 mg/dl) were excluded. APOs were defined as at least one of the following: fetal death after 12 weeks; neonatal death prior to hospital discharge; preterm delivery < 36 weeks due to gestational hypertension, preeclampsia or placental insufficiency; small for gestational age (<5^th percentile). We examined the role of age, race/ethnicity (non-Hispanic white vs. other), self-reported disability status, percentage of visits attended, and measures of SES including level of educational attainment and median income by zip code, in a series of bivariate and multivariate logistic regression models, clustering by site. For all analyses the referent group was white patients with SLE alone.

Results: Data were available for 408 women for the analyses; 6 had missing APO data and were omitted from the analysis. Mean age was 30.9 years and 50% were racial/ethnic minorities. Seventeen percent of non-Hispanic whites and 29% of minorities met criteria for APO. Minorities with SLE alone had higher odds of APO than their white counterparts, a difference which diminished after adjustment for covariates, including measures of SES such as level of educational attainment and median income by zip code. Both white and minority women with SLE and aPL had higher rates of APO compared to white patients with SLE alone. In this SLE and aPL group, the risk of APO in minority women was more than double that of white women, and these differences remained after adjustment for covariates.

Conclusion: In minority women with SLE alone, SES appears to account for a large portion of the elevated risk of APO. In contrast, in minority women with SLE and aPL, the elevated risk of APO persisted after adjustment for SES, and large disparities in APO remained. Further evaluation of disparities including clinical measures and more robust measures of SES are needed for better understanding.

Table: Unadjusted and Adjusted Odds of Adverse Pregnancy Outcomes in Women with SLE with and without APL
	Unadjusted		Adjusted^*
	White	Minority	White	Minority
SLE	reference	2.0 (1.0,4.1)	reference	1.6 (0.7,3.4)
SLE and aPL	3.3(1.4,7.1)	8.2 (2.3, 29.4)	3.7 (1.7,8.2)	7.3 (1.8,30.2)
Reported odds Ratio (CI). Race: individuals not self-identifying as non-Hispanic white were categorized as minorities. *Model adjusted for (1) Education: HS education or less (completed high school education or less), beyond HS (education beyond high school). (2) Age (3) Rheumatology visits: percentage of rheumatology study visits attendance (4) Median income: derived from zip code U.S and Canadian census data. (5) Disabled: self reported disability status. SLE defined as ≥ 4 revised ACR criteria. aPL defined as (at least one of the following on two occasions: anti-cardiolipin IgM or IgG ≥ 40 MPL units, anti-β2 glycoprotein IgM or IgG ≥ 40 MPL, positive lupus anticoagulant), both SLE and aPL:

Disclosure: S. Ferguson, None; E. Kaplowitz, None; L. Trupin, None; E. H. Yelin, None; P. P. Katz, None; J. E. Salmon, None.

To cite this abstract in AMA style:

Ferguson S, Kaplowitz E, Trupin L, Yelin EH, Katz PP, Salmon JE. The Role of Race/Ethnicity and SES in Adverse Pregnancy Outcome in SLE and Apl [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-role-of-raceethnicity-and-ses-in-adverse-pregnancy-outcome-in-sle-and-apl/. Accessed September 21, 2019.

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