Women With RA, SLE, and Their Infants, Have Greater Risk for Adverse Outcomes

Women with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have inadequate weight gain, longer hospital stays, and are more likely to be rehospitalized for nonpregnancy related causes after delivery, according to study results published in Arthritis Care and Research.

Obstetric outcomes among women with RA and SLE, and birth outcomes of their infants, including maternal and fetal rehospitalization rates have largely been undocumented. Increased knowledge of the postpartum experience of this population can identify risk factors for adverse outcomes, and inform management strategies postdelivery.

Using Washington State birth-hospital discharge data, which include inpatient information and discharges, a specific cohort was identified using multiple international classification of disease codes for RA and SLE. Using data compiled from 1987 to 2014, single-term gestations were identified for those with disease codes of interest.

In total, 1223 women with RA and 1354 women with SLE were selected for the study. For an unexposed cohort, 10 women per adverse diagnosis of RA or SLE were selected for analysis, cumulating in an unexposed cohort for RA and SLE of 12,293 and 13,751, respectively. 

Women with vs without RA and SLE more often needed intensive levels of prenatal care and were also more likely to have inadequate gestational weight gain.

Preeclampsia was reported more often during pregnancies of women with vs without RA and SLE. Preterm rupture of membranes was also more common among those with vs without RA and SLE. In addition, women with vs without RA and SLE had longer hospital stays, most often more than 6 days.

Infants of women with vs without RA and SLE were more likely to weigh less than 2500 g (5.5 lb), be small-for-gestational-age, delivered at less than 32 weeks, and require admission to the neonatal intensive care unit (NICU). 

Rehospitalization rates due to nonpregnancy-related causes during the first 2 years after delivery were also increased. Infants of women with these conditions were also more likely to be rehospitalized less than 2 years after delivery.

Musculoskeletal-related conditions were the most common cause for rehospitalization for women with RA and SLE (hazard ratio [HR], 19.1 for RA; HR, 29.8 for SLE).

Study limitations included the lack of information on disease activity, anti-Ro/anti-La (SSA/SSB) positivity, antiphospholipid positivity, and the medications used.

Researchers concluded, “Women with RA or SLE should be monitored closely in the year following delivery to minimize rehospitalization particularly during the first 6 months postpartum. Infants of women with SLE should be monitored closely following delivery and further study conducted to elucidate reasons for poor outcomes.”