Abstract
BackgroundPregnant women with systemic lupus erythematosus (SLE) have increased risk of adverse outcomes including disease flare, spontaneous abortion, preeclampsia/eclampsia, premature birth and maternal death. However, pregnancy outcomes among adolescents and young women with SLE have not been well-explored. Our objective was to compare risk of adverse pregnancy outcomes in adolescents and young women with SLE to risk among peers without SLE.MethodsWe studied the 2000–2011 Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) to estimate the prevalence of adverse pregnancy outcomes in women with SLE aged ≤ 21 years at time of delivery. Outcomes were compared to peers without SLE by using multivariate logistic regression to calculate odds ratios and risk differences. Additionally, differences in length of stay and total charges per hospitalization were described.ResultsThere were 8,791,391 unique pregnancies, of which 4002 occurred in young women with SLE. After adjustment for age, race, insurance type and quartile of median income based on patient ZIP code individuals with SLE had increased odds of pre-eclampsia/eclampsia (OR 3.2, 95% CI 2.3–4.6), maternal death (OR 80, 95% CI 10–604), preterm birth (OR 2.7, 95% CI 2–3.7), spontaneous abortion (OR 5.1, 95% CI 2.8–9.6), and induced abortion (OR 30, 95% CI 14–63). The increase in risk among women with SLE was greatest for preterm birth (RD 11%, 95% CI 6–16), pre-eclampsia/eclampsia (RD 9%, 95% CI 5–13), and spontaneous abortion (RD 4%, 95% CI 0.9–6). Risk difference for induced abortion was 2% with 95% CI 0.6–4, while the difference in risk for maternal death did not reach statistical significance (RD 0.4, 95% CI -0.4-1).ConclusionsAdolescents and young women with SLE experience increased risk of adverse, pregnancy-specific outcomes as compared to their peers, including pre-eclampsia/eclampsia, maternal death, preterm birth, spontaneous abortion, and induced abortion. Additionally, length of stay and total charges for hospitalization are increased.
Highlights
Pregnant women with systemic lupus erythematosus (SLE) have increased risk of adverse outcomes including disease flare, spontaneous abortion, preeclampsia/eclampsia, premature birth and maternal death
Information available for each hospitalization includes general hospital characteristics as well as patient information such as age, gender, race, quartile of median income based on patient ZIP code, and discharge diagnoses/procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
The logistic regression model for race “missingness” included patient age, number of chronic diseases, Nationwide Inpatient Sample (NIS) stratum, quartile of median income based on patient ZIP code, SLE status, and all maternal pregnancy outcome variables
Summary
Pregnant women with systemic lupus erythematosus (SLE) have increased risk of adverse outcomes including disease flare, spontaneous abortion, preeclampsia/eclampsia, premature birth and maternal death. Pregnancy outcomes among adolescents and young women with SLE have not been well-explored. Our objective was to compare risk of adverse pregnancy outcomes in adolescents and young women with SLE to risk among peers without SLE. Systemic Lupus Erythematosus (SLE) is a complex autoimmune condition that affects adolescents and young women of childbearing age. Risk factors associated with poor pregnancy outcomes among women with SLE include active disease, renal involvement, presence of anti-phospholipid antibodies, use of high doses of glucocorticoids, and fewer years of education [14,15,16,17,18]
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