Poor Preconceptional Cardiovascular Health Affects Pregnancy Outcomes in SLE

A pregnant woman having her blood pressure measured
A pregnant woman having her blood pressure measured
Poor preconception cardiovascular health affects pregnancy outcomes in women with SLE.

In women with systemic lupus erythematosus (SLE), preconceptional cardiovascular (CV) health indicators demonstrating poor or intermediate maternal health were associated with various pregnancy outcomes including preterm birth, infants who are small for gestational age, and lower gestational age at birth, according to findings published in The Journal of Rheumatology.

Women with SLE have an increased risk for adverse pregnancy outcomes such as preterm birth and infants who are small for gestational age, and maternal CV health can affect in utero fetal development, but the effect of individual CV factors on such outcomes had not previously been explored. In the first study of its kind, investigators categorized maternal CV health and evaluated the influence of suboptimal indicators on pregnancy.

A total of 261 patients  with SLE with 309 live births (median patient age at conception, 29.9 years; median disease duration, 5.5 years; 58% white) enrolled in the Hopkins Lupus Pregnancy Cohort between 1987 and 2015 were included in the analysis. Researchers recorded data on body mass index (BMI), blood pressure, and total cholesterol either at the last visit before conception or during the first trimester. These 3 health indicators were rated as ideal, intermediate, or poor, according to American Heart Association (AHA) guidelines. Primary outcomes were preterm birth, infants who were small for gestational age, and gestational age at birth.

There were 95 (31%) preterm deliveries and of the 293 births with birth weights available, 18% were small for gestational age and 4% were large for gestational age. Patients exhibited ideal BMI, blood pressure, and total cholesterol in 56%, 51%, and 85% of these pregnancies, respectively. When adjusted for prednisone use and race, intermediate BMI was correlated with a lower chance of having an infant who was small for gestational age (odds ratio [OR], 0.26; 95% CI, 0.11-0.63). In contrast, intermediate or poor blood pressure was linked to lower birth gestational age (β = −0.96; 95% CI, −1.62 to −0.29), and intermediate or poor cholesterol was associated with a higher risk for preterm birth (OR, 2.21; 95% CI, 1.06-4.62).

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Study limitations included the lack of preterm birth indications, missing CV health information for some live births, lack of data on 4 important AHA indices (diet, cigarette smoking, exercise, and glucose levels), data collection at a single center, and a small sample size that limited statistical power.

“Interventions to improve the CV health of patients prior to pregnancy would improve pregnancy outcomes, as well as benefit the long-term health of patients with SLE,” advised the authors. They recommended that in women looking to become pregnant, their CV health status be considered alongside SLE disease activity when assessing likely pregnancy outcomes and potential risks.

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Eudy AM, Siega-Riz AM, Engel SM, et al. Preconceptional cardiovascular health and pregnancy outcomes in women with systemic lupus erythematosus [published online July 15, 2018]. J Rheumatol. doi:10.3899/jrheum.171066