Lake Louise, Alberta—The first large study of pregnancy outcomes among women with childhood-onset systemic lupus erythematosus (cSLE) demonstrates a high incidence of stillbirths and spontaneous abortions.1 These data are similar in women with adult-onset SLE.
Together with the recently published results of the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and SLE) study—which identified possible biomarkers for negative pregnancy outcomes in women with lupus—these data may help significantly improve the care of these women, according to Deborah Levy, MD, MS, Staff Rheumatologist, The Hospital for Sick Children, Toronto, Canada, and colleagues at the 2016 Canadian Rheumatology Association Annual Scientific Meeting.1,2
“With respect to the PROMISSE study, yes, the results are relevant to the patient population we looked at in our study,” explained Dr Levy. “Certainly the treating rheumatologist and obstetrician now have more research data available to them to make treatment decisions.”
Determining Adverse Pregnancy Outcomes
The investigators sought to determine adverse pregnancy outcomes in women diagnosed with SLE before they turned age 18 years.1 The records from several administrative health databases were reviewed, and, overall, 502 women—diagnosed between January 1, 1984, and December 31, 2011, and aged 15 to 45 years at the time of the study—were identified and included in the analysis.
Of the 502 women included, 37% were Caucasian, and 24.1% were Asian. A total of 110 patients had ≥1 pregnancies, for a total of 244 pregnancies. There were 107 (44%) live births, 90 (37%) induced abortions, 39 (16%) spontaneous abortions, and 8 stillbirths (3% of all pregnancies, and 7% of all deliveries). Of the live births, there were 63 (59%) full-term and 44 (41%) preterm births. The rate of cesarean (C)-sections among the live births was 40% (43/107). The standardized incidence ratio of observed to expected live births in women with cSLE was 0.433.
Dr Levy and colleagues also found no significant differences in the early-disease characteristics—including major-organ involvement—between women who had ≥1 pregnancies, and those who did not have a pregnancy, or between those with ≥1 live births, and no live births.
Furthermore, the stillbirth rate was significantly higher than the Canadian average of 1% of deliveries. The preterm deliveries were also significantly higher than the Canadian average of 7% to 8%, and the 40% C-section rate was greater than the 26% average rate in Canada.
Women who had an induced abortion were significantly younger (mean age 22 years), compared with the average (age 27 years) among women who had a live birth, stillbirth, or spontaneous abortion.
“Our study is important to demonstrate that young women with childhood-onset SLE may have even worse pregnancy outcomes than those who develop SLE as adults, and should be followed very closely for adverse pregnancy events,” Dr Levy told Value-Based Care in Rheumatology. “More research is needed."
- Lee J, Fu L, Pope JE, et al. Pregnancy outcomes in women with childhood-onset systemic lupus erythematosus from a large population-based cohort. Poster presented at: 2016 Canadian Rheumatology Association Annual Scientific Meeting; February 17-20, 2016; Lake Louise, Alberta.
- Kim MY, Buyon JP, Guerra MM, et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. Am J Obstet Gynecol. 2016;214:108.e1-108.e14.