While investigators have known that maternal and fetal outcomes of pregnancy among women with systemic lupus erythematosus (SLE) have improved over time, it is unknown whether the improved outcomes are shared equally among different racial and ethnic groups. Lupus has been shown to disproportionately affect minorities of childbearing age. A new study that includes researchers from Hospital for Special Surgery (HSS) presented today at the American College of Rheumatology (ACR) annual meeting shows that pregnancy outcomes in women with lupus have improved in all racial and ethnic groups over the past decade, but disparities still exist.
“We’re happy to see pregnancy outcomes improved over time in all of the groups studied, however improvements were more evident in some groups than others,” said lead study author Bella Mehta, MBBS, MS, MD, a rheumatologist at HSS. “African Americans and Hispanics continue to have poor pregnancy outcomes. Further study is warranted to determine where resources are needed to improve access and care for these patients.”
In the new study, researchers used the National Inpatient Sample (NIS) to conduct a retrospective cross-sectional analysis of lupus and pregnancy related hospital admissions from 2008 to 2017. The NIS is the largest publicly available all-payer healthcare database designed to produce US regional and national estimates of inpatient utilization, access, cost, quality and outcomes. Patients with lupus were identified by using ICD-9/10 codes. The researchers evaluated the pregnancy outcomes of four groups: Caucasians, African Americans, Hispanics and Asians/Native Americans/Others. Outcomes included in-hospital maternal mortality, fetal mortality, non-delivery related admissions and Cesarean section (C-section).
The investigators found that from 2008 to 2017, there were a total of 61,012 SLE pregnancy related hospitalizations. The median age of pregnant women in the sample was 29 for African American and Hispanic women, 30 for Caucasians, and 31 for Asians/Native Americans/Others. African Americans and Hispanics were more likely to be on Medicaid (51% and 49% respectively) versus Caucasians (30%) and Asians/Native Americans/Others (33%).
During the 10-year study period, fetal mortality and non-delivery related admissions and C-section rates improved in all racial/ethnic groups. Maternal mortality rates were very low throughout the study period, with none observed among Caucasians. Overall fetal mortality declined in all racial/ethnic groups, with a numerically greater reduction in Hispanic (from 291 in 2008-2009 to 101 in 2016-2017 per 10,000 admissions) and Asian/Native American/Other (from 267 in 2008-2009 to no observations in 2016-2017 per 10,000 admissions) versus Caucasian (from 136 in 2008-2009 to 108 in 2016-2017 per 10,000 admissions) and African American (from 385 in 2008-2009 to 308 in 2016-2017 per 10,000 admissions). In the latest data from 2017, African Americans continued to have worse fetal mortality than Hispanic or Caucasian patients, and Asians/Native Americans/Others had the least fetal mortality. In data from 2017, African Americans had the most non-delivery admissions, followed by Hispanics, Asians/Native Americans/Others and Caucasians. In 2017, C-section rates were highest in African Americans, followed by Caucasians, Asians/Native Americans/Others, and Hispanics.
“We have learned over the years that patients with lupus can become pregnant but need to do so in a certain way. That is, they should have quiet disease activity at conception and they shouldn’t become pregnant if they have serious internal organ damage such as renal failure,” said study co-author Lisa R. Sammaritano, MD, a rheumatologist at HSS. “What this study shows is there is still a persistent disparity between non-Caucasian ethnic groups and Caucasians in terms of pregnancy outcomes in women with lupus, but both groups have had improvement over 10 years.
“It’s good to see that improvements have been across racial and ethnic groups, but we need to continue to work toward identifying the reasons disparities still exist,” she continued. “This kind of large database study is very useful in looking at this type of problem across the country as a whole, rather than a study focused on a single hospital system, as most other studies do.”
Authors: Bella Mehta1, Yiming Luo2, Deanna Jannat-Khah3, Jiehui Xu4, Lisa Sammaritano3, Jane Salmon3, Michael Lockshin1, Susan Goodman3 and Said Ibrahim5. 1Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, 2National Institutes of Health, Bethesda, MD, 3Hospital for Special Surgery, New York, NY, 4Weill Cornell Medicine, New York, NY, 5Weill Cornell Medicine, Cleveland, OH.
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 12th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2021-2022), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2021-2022). HSS is ranked world #1 in orthopedics by Newsweek (2021-2022). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.