WASHINGTON, DC—Pregnant women with lupus need to be followed closely by both a rheumatologist and an obstetrician experienced in high-risk pregnancies, because such patients have increased risks of infection and other serious complications during gestation, including a mortality risk 20 times higher than that in nonlupus pregnant mothers, according to findings from the largest study to date to track pregnancy complications in systemic lupus erythematosus (SLE). The research was presented by Megan Clowse, MD, assistant professor in the division of rheumatology and immunology at Duke University Medical Center, in Durham, NC, at the 70th annual meeting of the American College of Rheumatology (ACR), in Washington, DC.¹

The study used a national database to compare risks faced by pregnant women with and without lupus. Researchers examined the records of the more than 17,000 women with lupus who gave birth between 2000 and 2002. The risk of maternal mortality among women with SLE was twenty times higher than that of women without the disease, or 325/100,000 live births compared to 14/100,000 in non-SLE pregnancies.

"I definitely don't think we should prevent lupus patients from getting pregnant," Dr. Clowse said. "The majority of women with lupus can and will have a successful pregnancy and deliver a healthy child, with close follow-up by a rheumatologist and a high-risk obstetrician."

Study Included Data on Preeclampsia, Eclampsia, Antiphospholipid Syndrome

Compared with pregnant women without lupus, women with the disease were three times more likely to develop preeclampsia and four times more likely to develop eclampsia. Pregnant women with SLE were 2.6 times more likely than pregnant women without lupus to require a cesarean section; they were more likely to have diabetes, renal failure, antiphospholipid syndrome (APLS), and hypertension, and were more likely to experience a blood clot, stroke, or develop a life-threatening infection including sepsis and pneumonia. In addition, women with SLE were more likely to have low blood platelet counts and anemia during delivery, which may contribute to their threefold increased need for transfusion during pregnancy.

Though the risk for urinary tract infection was three times higher among lupus patients, the risk for pyelonephritis was not increased among lupus patients, the study found. The reported rates for obesity, smoking, and substance abuse were not significantly higher among women with SLE.

But most rheumatologists say the new findings look more scary than necessary. "The relative risk looks scary, but the numbers are still really small," John Cush, MD, the chief of rheumatology at Presbyterian Hospital, in Dallas, and a clinical professor of internal medicine at the University of Texas-Southwestern School of Medicine, told CIAOMed. "It's not an alarm, it's a red flag."

Lupus patients need to carefully plan their pregnancy and have the right people involved, he said. "The idea is we want to get the lupus under control first and make sure the patient is on the right therapies, and then they will deliver happy and healthy babies," he said.

Dr. Cush said the beauty of the new study lies in the size of the database, "It provides us with important, but rare data on eclampsia and preeclampsia," he said.

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