SLE is an autoimmune disorder that typically affects women in their childbearing years. Evidence shows that foetal and maternal mortality have declined in SLE over the years, but little is known about morbidity. At the EULAR Congress, Dr Bella Mehta presented findings from a retrospective study in over 50,000 women with SLE and delivery-related hospital admissions.
The group’s findings show patients with SLE had a higher risk of foetal morbidity than women without SLE. This included higher risk of intrauterine growth restriction and preterm delivery. SLE patients also faced a greater risk of blood transfusion, puerperal cerebrovascular disorders, acute renal failure, eclampsia or disseminated intravascular coagulation, cardiovascular and peripheral vascular disorders, and general medical issues than those without SLE. These important new insights will help inform the management of pregnancy in women with SLE.
In SpA, findings have not been uniform, with some studies reporting increased pregnancy risks while others have failed to identify any significant differences between women with and without SpA. Matilda Morin’s abstract shared findings from a nationwide register-based study of singleton births between April 2007 and December 2019 in women diagnosed with ankylosing spondylitis (AS) or undifferentiated SpA.
Overall, women with SpA were found to be at increased risk of several adverse outcomes. In particular, there was an increased risk of gestational diabetes, elective and emergency Caesarean delivery, and preterm birth including spontaneous preterm birth. The risk estimate for preeclampsia was also increased, but failed to reach significance. Infants born to mothers with SpA were not more likely to be born small for gestational age (SGA), but there was a slightly increased risk estimate of infection during their first year of life.
The authors conclude that, while most pregnancies in women with SpA are uneventful, there is an increased risk for a number of adverse pregnancy outcomes.
The impact of RA and its treatment on pregnancy was also presented, in an abstract from Sabrina Hamroun and colleagues. A favourable pregnancy outcome was found in 56.5% of the 92 women in the cohort.
The most common unfavourable outcomes were premature birth and SGA, observed in 16.9% and 20.5%, respectively. The group also ran a multivariate model, which found an association between unfavourable pregnancy outcomes and first-time deliveries, age, and exposure to corticosteroids during pregnancy.
The issue of medication use during pregnancy was also covered by Dr Dina Zucchi and colleagues, in their work on adherence to medication during pregnancy in women with systemic autoimmune disease. Overall, pregnant patients had good adherence to prescribed medication – although 25% did not take therapies adequately despite close monitored in a dedicated clinic for high-risk pregnancies and having received adequate pregnancy counselling. The findings suggest that anxiety may be a key determinant of low adherence, both in pregnant and nonpregnant women.