OP0124 FETAL AND MATERNAL MORBIDITY IN PREGNANT SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS: A 10-YEAR U.S. NATIONAL STUDY

Abstract

BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disorder that affects women in their childbearing years. Previously, we demonstrated that fetal and maternal mortality has declined in SLE patients over the years, however little is known about morbidity (1).ObjectivesTo determine the proportion of fetal and maternal morbidity in SLE deliveries compared to non-SLE deliveries in a US nationwide study over a decade.MethodsWe used retrospective data from the National Inpatient Sample database to identify all delivery related hospital admissions of patients with and without SLE from 2008 to 2017 using ICD-9 (710.0) and 10 (M32*) codes. Fetal morbidity indicators included preterm delivery and intrauterine growth restriction. 21 indicators of severe maternal morbidity were identified using the standard CDC definition: these are unexpected outcomes of labor and delivery that result in significant short- or long- term consequences to a woman’s health (2). Descriptive statistics and their 95% confidence intervals were calculated using sample weights from the dataset.ResultsAmong the 40 million delivery-related admissions, 51,161 patients (10,297 unweighted) were reported to have SLE. SLE patients were more likely to be older and have more comorbidities compared to non-SLE patients (Table 1). Patients with SLE had a higher risk of fetal morbidity, including intrauterine growth restriction (8.0% vs 2.7%) and preterm delivery (14.5% vs 7.3%) than patients without SLE. Amongst the CDC maternal morbidity indicators - SLE patients faced a greater risk of blood transfusion, puerperal cerebrovascular disorders, acute renal failure, eclampsia or DIC, cardiovascular and peripheral vascular disorders, and general medical issues than those without SLE (Figure 1).Table 1.Characteristics for deliveries of patients with and without Systemic Lupus ErythematosusSLE deliveriesNon-SLE deliveriesPercent (%)(95 %CI)Percent (%)(95 %CI)N51,161* (10,297 unweighted)(49,419.14, 52,903.37)40,000,000* (8,055,025 unweighted)(39,200,000; 40,700,000)Age (years)30.05(29.92, 30.18)28.19(28.14, 28.24)RaceWhite46.15(44.83, 47.47)52.43(51.74, 53.11)African American24.68(23.55, 25.85)15.01(14.62, 15.42)Hispanic18.48(17.40, 19.60)21.45(20.81, 22.10)Other10.69(9.93, 11.50)11.11(10.76, 11.47)InsuranceMedicare5.32(4.83, 5.86)0.7(0.66, 0.75)Medicaid38.2(37.00, 39.41)43.79(43.20, 44.39)private insurance51.84(50.55, 53.13)49.8(49.15, 50.45)self-pay1.39(1.13, 1.70)2.74(2.57, 2.92)no charge0.04(0.02, 0.12)0.13(0.09, 0.18)other3.21(2.84, 3.63)2.84(2.73, 2.95)Elixhauser00(*no obs)80.56(80.32, 80.80)1 to 497.84(97.50, 98.12)19.4(19.16, 19.64)5+2.16(1.88, 2.50)0.04(0.03, 0.04)*Population weighted values are listed.Figure 1.Fetal and severe maternal morbidity outcomes in Systemic Lupus Erythematosus (SLE) and non-SLE patients. Cardiovascular and peripheral vascular disorders include acute myocardial infarction, aneurysm, amniotic fluid embolism, cardiac arrest/ventricular fibrillation, heart failure, pulmonary edema/acute heart failure, sickle cell disease with crisis, air and thrombotic embolism, and conversion of cardiac rhythm. General medical issues include hysterectomy, shock, sepsis, adult respiratory distress syndrome, and severe anesthesia complications, temporary tracheostomy, and ventilation.ConclusionOur study demonstrates that fetal morbidity and severe maternal morbidity occur at a higher rate in patients with SLE compared to those without, even in this most recent decade. This work can help inform physicians to counsel and manage patients with SLE during pregnancy and its planning.