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VBCR - Conference Highlights - ACR 2013, Lupus

Systemic lupus erythematosus (SLE) often affects women of childbearing age. Pregnant women with SLE are known to be at increased risk of miscarriage and other complications during pregnancy. However, a careful quantitative analysis of this risk has not been performed in the United States. In a new study by Petri and colleagues (Abstract 2534), investigators used a large health claims database to quantify the reported incidence of maternal and fetal complications in pregnant women with SLE compared with pregnant women without SLE.

In this retrospective observational analysis of an administrative healthcare claims database in the United States, the records of 1721 pregnancies of women with SLE were matched with 8605 pregnancies of women without SLE. The demographics in the 2 groups were similar with respect to age and medical history of the women.  In this study, patients with SLE received  methotrexate, mycophenolate mofetil, hydroxychloroquine, and/or other immunosuppressant agents.

In the women with SLE, 23 of every 100 pregnancies resulted in a miscarriage before 22 weeks of gestation compared with 19 of every 100 pregnancies in women without SLE (P <.0001). Hypertension was reported in 28% of SLE pregnancies compared with 12% of the controls (P <.0001), and preeclampsia occurred in 10% of SLE pregnancies compared with 4.5% of the controls (P <.001). Preterm delivery between 22 weeks and 37 weeks gestation occurred in 11.4% of SLE pregnancies versus 5.9% of the controls (P <.0001), with stillbirths reported in 2.4% of women with SLE and in 1.3% of women without SLE (P = .0019). Moreover, there was a 7.5% increase in the risk of fetal complications in the pregnancies of women with SLE versus the pregnancies of women without SLE, with known or suspected fetal abnormalities affecting the management of the mother in almost 40% of the women with SLE compared with 28% of the controls (P <.0001).

Healthcare utilization was significantly greater in the pregnant women with SLE compared with pregnant women without SLE, including the use of fetal echocardiograms, fetal stress and nonstress testing, fetal ultrasound, the number of days spent in the maternity ward, and the number of visits to the obstetrician’s office. The mean total all-cause direct healthcare costs during the 44-week pregnancy and postpartum period was $21,509 for the pregnant women with SLE compared with $11,841 for the pregnant women without SLE (P <  .0001). Moreover, for pregnant women with SLE compared with nonpregnant women with SLE, the mean total all-cause direct healthcare costs were $20,665 versus $12,591 (P < .0001).

These results show that pregnant women with SLE have significantly higher healthcare resource utilization and costs than pregnant women without SLE.

This large, quantitative, observational analysis showed that women with SLE had a significantly greater risk for fetal abnormalities affecting the care of the mother; pregnant women with SLE were twice as likely to develop serious maternal complications, and utilized higher healthcare resources, compared with women without SLE.

This study highlights the need for regular physician-patient interaction, counseling, and high-quality education for women with SLE who are pregnant or who are considering pregnancy to ensure that possible complications are recognized early and are  managed appropriately.

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Last modified: May 21, 2015
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