Abstract
The objective of the study was to examine pregnancy outcomes in women with systemic lupus erythematosus (SLE) and population controls in Trinidad. We performed a cross-sectional analysis of adverse outcomes in pregnancies of Afro-Caribbean women with SLE and without SLE. One hundred and twenty-two female adult cases of SLE and 203 neighbourhood age-matched women without SLE were interviewed concerning details of their reproductive history, and the anticardiolipin antibody (ACL) status was established for women with SLE. A total of 1,029 pregnancies were reported (356 by women with SLE, 673 by women without SLE). In women with ≥ 1 pregnancy the total number of pregnancies was similar in women with a diagnosis of SLE and women without; however, a lower proportion of women with SLE had ever been pregnant compared with women without SLE (80% versus 91%, P = 0.002). In multivariate logistic regression analyses adjusted for maternal age, district of residence, pregnancy order and smoking, SLE pregnancies were more than twice as likely to end in foetal death than non-SLE pregnancies (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.2–4.7). This effect was driven by a large increase in the odds of stillbirth (OR, 8.5; 95% CI, 2.5–28.8). The odds of early miscarriage (OR, 1.4; 95% CI, 0.6–3.1) and of mid-trimester miscarriage (OR, 1.9; 95% CI, 0.4–9.5) were higher, but were not statistically significantly different, in SLE pregnancies than in non-SLE pregnancies. The odds of ectopic pregnancy (OR, 7.5; 95% CI, 0.9–62.5) and of preterm birth (OR, 3.4; 95% CI, 1.2–10.0) were higher in SLE pregnancies conceived after diagnosis than in non-SLE pregnancies. There was no evidence of raised levels of IgG or IgM ACL among the majority (93/97 women, 96%) of SLE cases who reported sporadic mid-trimester miscarriage or stillbirth, although there was evidence of high levels of IgM and IgG ACL among women reporting three or more miscarriages and three consecutive miscarriages, and of raised IgG ACL among those experiencing ectopic pregnancy. In conclusion, we found evidence for a large increase in risk of stillbirth in the pregnancies of Afro-Caribbean Trinidadian women with SLE (not accounted for by high ACL status). There was some evidence of an increased risk of preterm delivery and ectopic pregnancy in pregnancies conceived after a diagnosis of maternal SLE.
Highlights
Systemic lupus erythematosus (SLE) is a complex autoimmune disease that predominantly affects females of childbearing age, with both genetic and environmental determinants, and is common in Afro-Caribbean populations
In multivariate logistic regression analyses adjusted for maternal age, district of residence, pregnancy order and smoking, systemic lupus erythematosus (SLE) pregnancies were more than twice as likely to end in foetal death than non-SLE pregnancies (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.2–4.7)
We found evidence for increased risk of all miscarriage, and ectopic pregnancies
Summary
Systemic lupus erythematosus (SLE) is a complex autoimmune disease that predominantly affects females of childbearing age (female:male ratio approximately 9:1), with both genetic and environmental determinants, and is common in Afro-Caribbean populations. SLE has a well-recognised association with second-trimester miscarriage; studies have examined other adverse pregnancy outcomes including prematurity and pregnancy loss [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. Some of these studies, are based on small numbers and/or tertiary referral centres with many high-risk patients, and few studies involved a comparison group [2,8]. Preliminary work carried out by the authors suggested there may be approximately 373 cases of SLE in Northern Trinidad (see Discussion), with a population denominator of approximately 170,000 adult females [22] – giving a crude SLE prevalence of approximately 219 per 100,000 in females in Trinidad
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