ACR: Lupus Increases Pregnancy and Disease-Related Risks

WASHINGTON, Nov. 12 -- Pregnant women with systemic lupus erythematosus face sharply increased risks of a range of both disease-related and pregnancy complications, researcher said here.

Compared with the general population of pregnant women, those with lupus are 20 times more likely to die and are at increased risk of both complications of the pregnancy and other medical events, according to Megan Clowse, M.D., of the Duke University Medical Center in Durham, N.C.

The mortality rate "certainly is a shocking number," Dr. Clowse said as she presented her data in a poster session during the American College of Rheumatology meeting.

But while the odds ratio compared to other women is high, she said, it works out to 0.3% of pregnant women with lupus - which is actually lower than the 1% to 2% annual mortality from the disease itself.

"One of the few things that cause death in 20-year-old women is lupus," Dr. Clowse said, and it may be that the mortality rate among those who get pregnant is relatively lower simply because the sickest women do not get pregnant.

"If you're extraordinarily ill, hopefully you're not getting pregnant," she said.

In a retrospective study from 2000 through 2002, Dr. Clowse and colleagues used figures from the Nationwide Inpatient Sample, which includes demographic and International Classification of Diseases (ICD-9) data from U.S. hospitals.

During that time, there were more than 18.3 million pregnancy-related hospital admissions, Dr. Clowse said, of which 17,262 (0.01%) involved women with lupus.

Women with lupus were significantly more likely to suffer complications of pregnancy as well as other medical complications, the researchers found. Specifically, women with lupus:

•Were 2.6 times more likely to need a Caesarian delivery, three times more likely to have pre-eclampsia, and four times more likely to have eclampsia.

•Were 2.6 times more likely to have low-birth-weight babies.

•Had 2.2 times the risk of stroke, 3.2 times the risk of pulmonary embolism, and 5.8 times the risk of deep vein thrombosis.

•Had 3.5 times the risk of sepsis and 4.3 times the risk of pneumonia.

The women were also more likely to have comorbid conditions that make the pregnancy risky. Compared with the general population, they were:

•36.9 times more likely to have some degree of renal failure.

•34.7 times more likely to have thrombophilia

•5.5 times more likely to have hypertension.

•And 1.7 times more likely to have gestational diabetes.

All of the results were highly statistically significant, at P-values less than 0.001, Dr. Clowse said.

The study "points out that women with lupus are at definitely high risk from both their lupus and the pregnancy" Dr. Clowse said. "It mandates that these women be seen by a rheumatologist throughout their pregnancy and by a high-risk obstetrician, not just a regular obstetrician."

The mortality figure, among the others, is "an attention-grabbing risk," commented Eric Matteson, M.D., of the Mayo Clinic in Rochester, Minn., although he noted that the absolute number of deaths remains low.

The study "does tell us that we have to be very attentive if we know that the woman has lupus because she has a higher likelihood of having a pregnancy-related complication," Dr. Matteson said.

At the Mayo Clinic, he and his colleagues designate any woman who has lupus and is pregnant as "high-risk" and follow her closely to deal with complications as they arise.

"Women with lupus," he said, "can have a successful pregnancy, but they need special attention."