Trends in systemic lupus erythematosus pregnancy outcomes in the United States

1. In this retrospective cohort study, the authors observed that the greater decline in in-hospital maternal mortality was found for systemic lupus erythematosus (SLE) pregnancies compared to non-SLE pregnancies.

2. Despite reductions in in-hospital maternal mortality for SLE pregnancies, the rates still remain high and improvements are needed.

Evidence Rating Level: 2 (Good)

Study Rundown: Systemic lupus erythematosus (SLE) is an autoimmune condition that affects women of child-bearing age. During pregnancy, patients with SLE are at higher maternal and fetal risk of complications due to the nature of this disease. The authors of this study aimed to assess nationwide trends between 1998 to 2015 in the United States regarding maternal and fetal complications among pregnant women with SLE. The National Inpatient Sample (NIS) was used to conduct this study. The authors found that there was a significant improvement in in-hospital maternal mortality for both SLE and non-SLE pregnancies over the 18 year period, with the greatest improvements occurring for SLE-related pregnancies. One of the limitations of this study was generalizability, as the data set only contained hospitalized patients and therefore other outpatient information was not incorporated into the study, such as miscarriages or outpatient deliveries.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: A Critical Review on Obstetric Follow-up of Women Affected by Systemic Lupus Erythematosus 

In-Depth [retrospective cohort study]: The authors of this retrospective cohort study utilized data from the NIS database from 1998 to 2015 in the United States. They utilized International Classification of Diseases, Ninth and Tenth Revision (ICD-9, ICD-10) codes to identify and include all pregnancy-related hospital admissions of patients with SLE as well as those without. They then assessed in-hospital maternal and fetal mortality, as well as other trends, associated with these admissions. A total of 0.12% of all pregnancies during this period were found to be SLE-related. The authors observed that there were higher rates of in-hospital maternal mortality (180 vs. 12 deaths per 100 000 admissions), fetal mortality (180 vs. 65 deaths per 10 000 admissions), preeclampsia or eclampsia (8.8% vs. 3.5%) and C-sections (40% vs. 29%) in patients with SLE compared to those without SLE throughout the study period. For both cohorts of patients, the in-hospital maternal mortality declined in those with SLE (442 deaths per 100 000 admissions in 1998 to 2000 vs. < 50 deaths per 100 000 admissions in 2013 to 2015) and those without SLE (13 deaths per 100 000 admissions vs. 10 deaths per 100 000 admissions in 2013 to 2015). The decrease in maternal mortality in patients with SLE was statistically significant (P = 0.002). Similar trends were observed for fetal mortality, although the difference in reduction was not statistically significant.

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