OBSTETRICS
Maternal and Neonatal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus: A Population-Based Study

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Abstract

Objective

To determine maternal and neonatal outcomes in pregnancies complicated by systemic lupus erythematosus (SLE).

Methods

In a retrospective cohort study using the Nova Scotia Atlee Perinatal Database, 97 pregnancies in women with SLE, with 99 live births, were compared with 211 355 pregnancies in women without SLE and their 214 115 babies. All were delivered in Nova Scotia between 1988 and 2008.

Results

In women with SLE, gestational age at birth and mean neonatal birth weight were lower (P < 0.001) than in women without SLE. On bivariate analysis, severe preeclampsia, Caesarean section, newborn resuscitation for > 3 minutes, respiratory distress syndrome, assisted ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, mild to moderate intraventricular hemorrhage, retinopathy of prematurity, and congenital heart block in neonates were significantly more frequent in the women with SLE.

Logistic regression analysis identified that having SLE increased the risks of Caesarean section (OR 1.8; 95% CI 1.1 to 2.8, P = 0.005), postpartum hemorrhage (OR 2.4; 95% CI 1.3 to 4.3, P = 0.003), need for blood transfusion (OR 6.9; 95% CI 2.7 to 17, P = 0.001), postpartum fever (OR 3.2; 95% CI 1.7 to 6.1, P = 0.032), small for gestational age babies (OR 1.7; 95% CI 1.005 to 2.9, P = 0.047), and gestational age ≤ 37 weeks (OR 2.1; 95% CI 1.3 to 3.4, P = 0.001). Neonatal death was not shown to be more common in women with SLE (RR 3.05; CI 0.43 to 21.44, P = 0.28).

Conclusion

Mothers with SLE have an increased risk of Caesarean section, postpartum hemorrhage, and blood transfusion. They are more likely to deliver premature babies, smaller babies, and babies with congenital heart block.

Résumé

Objectif

Déterminer les issues maternelles et néonatales dans les cas de grossesse compliquée par le lupus érythémateux disséminé (LED).

Méthodes

Dans le cadre d’une étude de cohorte rétrospective menée au moyen de la Nova Scotia Atlee Perinatal Database, 97 grossesses chez des femmes présentant le LED (ayant donné lieu à 99 naissances vivantes) ont été comparées à 211 355 grossesses chez des femmes ne présentant pas le LED (ayant donné lieu à 214 115 naissances vivantes). Toutes ces femmes ont accouché en Nouvelle-Écosse entre 1988 et 2008.

Résultats

Chez les femmes présentant le LED, l’âge gestationnel à la naissance et le poids de naissance moyen étaient inférieurs (P < 0,001) à ceux qui ont été constatés chez les femmes ne présentant pas le LED. Dans le cadre de l’analyse bivariée, nous avons constaté que la prééclampsie grave, la césarienne, la réanimation néonatale menée pendant > 3 minutes, le syndrome de détresse respiratoire, la ventilation assistée, la dysplasie bronchopulmonaire, la persistance du canal artériel, l’hémorragie intraventriculaire allant de légère à modérée, la rétinopathie des prématurés et le bloc cardiaque congénital chez les nouveau-nés étaient considérablement plus fréquents chez les femmes présentant le LED.

L’analyse par régression logistique a déterminé que le fait de présenter le LED entraînait une hausse des risques de césarienne (RC, 1,8; IC à 95 %, 1,1 - 2,8, P = 0,005), d’hémorragie postpartum (RC, 2,4; IC à 95 %, 1,3 - 4,3, P = 0,003), de voir une transfusion sanguine s’avérer nécessaire (RC, 6,9; IC à 95 %, 2,7 - 17, P = 0,001), de fièvre puerpérale (RC, 3,2; IC à 95 %, 1,7 - 6,1, P = 0,032), d’hypotrophie fœtale (RC, 1,7; IC à 95 %, 1,005 - 2,9, P = 0,047) et de constater un âge gestationnel ≤ 37 semaines (RC, 2,1; IC à 95 %, 1,3 - 3,4, P = 0,001). Il n’a pas été démontré que le décès néonatal était plus courant chez les femmes présentant le LED (RR, 3,05; IC 0,43 - 21,44, P = 0,28).

Conclusion

Les mères présentant le LED sont exposées à un risque accru de césarienne, d’hémorragie postpartum et de transfusion sanguine. Elles sont plus susceptibles d’accoucher d’enfants prématurés, plus petits que la normale et présentant un bloc cardiaque congénital.

Section snippets

INTRODUCTION

Systemic lupus erythematosus is an autoimmune disease with a lifetime incidence in white women of 1 in 700.1 Specific factors such as active disease during pregnancy, renal involvement, antiphospholipid antibodies, hypertension, and antibodies to Ro/SSA and La/SSB are associated with unfavourable maternal and neonatal outcomes.2,3

Treatment required for SLE such as glucocorticoids may increase the risk of gestational diabetes, preeclampsia, and fetal growth impairment during pregnancy.2,4

MATERIAL AND METHODS

Information for the study was obtained from the Nova Scotia Attlee Perinatal Database, which contains detailed information on maternal characteristics, labour and delivery events, neonatal diagnoses, and procedures for all women who give birth in Nova Scotia and, where possible, for those women from Nova Scotia who deliver outside the province. Information in the database was collected from antenatal records and medical charts by trained personnel using standardized forms. An ongoing data

RESULTS

Of 211 452 women, there were 97 pregnancies in 77 patients with SLE (the SLE group) during the study period. Among 99 neonates in the SLE group, there were 52 males (52.5%) and 47 females (47.5%), a ratio that was not different from the non-SLE group (P = 0.7). Ninety-three of the 97 pregnancies in the SLE group (96.9 %) were singletons (not different from non-SLE; P = 0.12). Forty-four women (45.8%) were nulliparous, similar to the 44.7% non-SLE mothers (P = 0. 8). On bivariate analysis, there

DISCUSSION

According to Statistics Canada (2006), the Nova Scotian population included 24 175 (2.5%) Aboriginal and 878 915 non-Aboriginal people including various ethnic groups. Visible minorities made up 4% of the population, including 2% of Black ancestry.10

The prevalence of SLE in women in Nova Scotia whose pregnancies had reached 20 weeks’ gestation during this 20-year period was 0.046%, similar to that reported in a California population in 2001 (0.05%).11 Ethnicity in that population was different

CONCLUSION

Our population-based study provides information on maternal and neonatal outcomes in pregnancies complicated by SLE to assist antenatal counselling and preparation of parents for the birth of their babies. In addition to increased pregnancy loss, there is an increased risk of earlier delivery, delivery by Caesarean section, postpartum hemorrhage, and postpartum fever, and a greater need for blood transfusion, and. In the absence of congenital heart block, adverse outcomes for babies are related

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Copyright © 2013 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.