Black women with systemic lupus erythematosus (SLE) vs those in the general population are at an increased risk for adverse perinatal outcomes, such as preterm and small-for-gestational-age (SGA) births, before and after SLE diagnosis, according to study results published in Arthritis Care & Research (Hoboken).
The objective of the study was to assess pregnancy outcomes, including preterm and SGA births, among Black women with SLE vs those in the general population.
Researchers collected data from the Georgia Lupus registry and the Georgians Organized Against Lupus Cohort of 583 Black women with SLE. A total of 11,660 Black women in the general population of metropolitan Atlanta whose data were obtained from the National Center for Health Statistics were also included in the study. Sampling was conducted to achieve a 1:20 ratio of SLE births to general population births.
The current analysis was restricted to singleton births, which were categorized into those occurring more than 3 years before SLE diagnosis, 0 to 3 years before SLE diagnosis, 0 to 3 years after SLE diagnosis, and more than 3 years after SLE diagnosis.
In models adjusted for maternal age, education, and parity, women with SLE were more likely to deliver preterm or have SGA infants 0 to 3 years before an SLE diagnosis (risk ratio [RR], 1.71; 95% CI, 1.24, 2.35), 0 to 3 years after an SLE diagnosis (RR, 2.29; 95% CI, 1.70, 3.09), and 3 or more years after an SLE diagnosis (RR, 2.83; 95% CI, 2.36-3.38). However, compared with the general population, women with SLE were not more likely to have a preterm or SGA birth 3 or more years before SLE diagnosis (RR, 1.03; 95% CI, 0.77-1.38).
Researchers noted that the unadjusted estimates were of a similar pattern and magnitude with the greatest increased risk occurring among women with SLE within 3 years after diagnosis. Moreover, the risk for SGA birth was 10.9% more than 3 years before SLE diagnosis, but 27.9% within 3 years after SLE diagnosis.
Study limitations included lack of data on SLE disease activity, hypertension, and diabetes diagnoses, and the medications taken during pregnancy. Moreover, the general population group may have included women with an SLE diagnosis, and the researchers were not able to exclude these patients based on birth certificate data. In addition, differentiation between medically indicated and spontaneous preterm births were not possible.
The researchers concluded, “As the prognosis for women diagnosed with SLE improves, more women with SLE will likely pursue pregnancy and childbearing.” They added, “More work remains to be done to characterize the additional risks around pregnancy and childbirth that [Black] women with SLE face. Healthcare providers, especially those in communities of color, should be better educated about SLE, and have a lower threshold to suspect SLE in the peripartum period.”
Angley M, Drews-Botsch, Lewis TT, et al. Adverse perinatal outcomes before and after diagnosis with systemic lupus erythematosus among African American women. Arthritis Care Res (Hoboken). Published online November 17, 2021. doi:10.1002/acr.24848