S Yasmeen1, E E Wilkins, N T Field, R A Sheikh, W M Gilbert. 1. Department of Obstetrics and Gynecology, Center for Health Services Research in Primary Care, University of California Davis, USA. syasmeen@ucdavis.edu
Abstract
OBJECTIVE: The purpose of this study was to examine pregnancy outcomes in women with systemic lupus erythematosus (SLE). STUDY DESIGN: Data from the California Health Information for Policy Project, which links records from birth certificates and hospital discharge records of mothers and newborns who delivered in all civilian hospitals in the state of California between 1 January 1993 and 31 December 1994, were retrospectively reviewed. Patients with a singleton gestation were stratified into the study group if they had a diagnosis of SLE, based on the International Classification of Disease, 9th Revision, or into the control group if they did not have SLE and delivered during the interval from 1 January 1994 to 31 December 1994. Specific maternal outcomes including pregnancy complications and fetal and neonatal outcomes were assessed and compared between the two groups. RESULTS: During the 2-year study period, 555 women had a diagnosis of SLE, and approximately 600000 women were included in the control group in the year 1994, giving a point prevalence of 0.05%. Specific adverse pregnancy outcomes, including hypertensive complications, renal disease, preterm delivery, non-elective Cesarean section, postpartum hemorrhage and delivery-related deep vein thrombosis all occurred more frequently in the SLE group as compared to controls (p < 0.001). Additionally, neonatal and fetal outcomes were significantly worse in the SLE group, as documented by a higher prevalence of fetal growth restriction and neonatal death, as well as longer hospital stays (p < 0.0001). CONCLUSION: SLE was associated with a significant increase in maternal pregnancy complications and in fetal and neonatal morbidity and mortality as compared to the control population. However, our population-based study found significantly fewer adverse outcomes than were previously reported. This may represent a more accurate clinical picture of the impact of SLE on pregnancy outcomes.
OBJECTIVE: The purpose of this study was to examine pregnancy outcomes in women with systemic lupus erythematosus (SLE). STUDY DESIGN: Data from the California Health Information for Policy Project, which links records from birth certificates and hospital discharge records of mothers and newborns who delivered in all civilian hospitals in the state of California between 1 January 1993 and 31 December 1994, were retrospectively reviewed. Patients with a singleton gestation were stratified into the study group if they had a diagnosis of SLE, based on the International Classification of Disease, 9th Revision, or into the control group if they did not have SLE and delivered during the interval from 1 January 1994 to 31 December 1994. Specific maternal outcomes including pregnancy complications and fetal and neonatal outcomes were assessed and compared between the two groups. RESULTS: During the 2-year study period, 555 women had a diagnosis of SLE, and approximately 600000 women were included in the control group in the year 1994, giving a point prevalence of 0.05%. Specific adverse pregnancy outcomes, including hypertensive complications, renal disease, preterm delivery, non-elective Cesarean section, postpartum hemorrhage and delivery-related deep vein thrombosis all occurred more frequently in the SLE group as compared to controls (p < 0.001). Additionally, neonatal and fetal outcomes were significantly worse in the SLE group, as documented by a higher prevalence of fetal growth restriction and neonatal death, as well as longer hospital stays (p < 0.0001). CONCLUSION:SLE was associated with a significant increase in maternal pregnancy complications and in fetal and neonatal morbidity and mortality as compared to the control population. However, our population-based study found significantly fewer adverse outcomes than were previously reported. This may represent a more accurate clinical picture of the impact of SLE on pregnancy outcomes.