July 12, 2019
In years past, doctors had advised most women with lupus to avoid getting pregnant because of the high risk for both mother and fetus. A newly published study in Annals of Internal Medicine by Dr. Bella Mehta shows that more women with lupus are having successful pregnancies, while the accompanying editorial by Dr. Megan E.B. Clowse provides insights into why.
Dr. Mehta is an Assistant Attending Physician at Hospital for Special Surgery (HSS) and an Assistant Professor in clinical medicine at Weill Cornell Medicine. She worked with colleagues from these institutions as well as the Icahn School of Medicine at Mount Sinai and New York-Presbyterian/Weill Cornell Medical Center to analyze 1998-2015 data from the National Inpatient Sample (NIS) database about pregnant women with and without lupus who were hospitalized. The NIS contains data on more than seven million hospital stays.
The team looked at deaths of pregnant women and their fetuses while in the hospital and dangerous complications of preeclampsia and eclampsia (degrees of high blood pressure that threaten the lives of mother and baby). Other measurements include the percent of caesarean births as well as admissions to the hospital not related to delivery or the length of stay.
Based on the database records, about 93,820 pregnant women with lupus and 78,045,054 without lupus were hospitalized in the US from 1998 through 2015. The statistics showed much improvement in in-hospital maternal and fetal mortality and in overall outcomes. Far fewer deaths occurred in hospitals, and the drop was greater among women with lupus.
The study authors concluded that despite these results, “improvement is still needed, because SLE pregnancy risks remain high.”
“Dr. Mehta’s study supports the important message that successful pregnancies can be achieved in patients with SLE,” commented Physician-in-Chief and Chair of the Department of Medicine at Hospital for Special Surgery and Chief of the Division of Rheumatology at HSS and NewYork-Presbyterian/Weill Cornell Medical Center, Mary K. Crow, MD . “We have learned that when patients become pregnant at a time of relatively low disease activity, there is a high likelihood of good outcomes for both mother and fetus. Of course there is still much work to be done to define the underlying immunologic mechanisms of SLE and to develop effective and safe therapies.” Dr. Crow also serves as Director of the Autoimmunity and Inflammation Research Program and Co-Director of the Mary Kirkland Center for Lupus Research at HSS as well as co-chair of the Lupus Research Alliance (LRA) Scientific Advisory Board.
In an editorial on the study, Dr. Clowse wrote, “Thirty years ago, most women with SLE were advised to avoid pregnancy because of high risks for maternal and fetal morbidity and mortality. Now, this advice has shifted entirely, and most women with SLE, with careful management, can safely build a family thanks to several developments.”
She attributes this improvement to several factors: the current practice to give drugs like hydroxychloroquine, immunosuppressants and aspirin during pregnancy to maintain low disease activity and to prevent flares and complications like antiphospholipid syndrome, preeclampsia and eclampsia. Getting pregnant disease activity is low is also key for successful outcomes. Dr. Clowse also notes the aid from guidelines by the American College of Obstetrics and Gynecology to monitor women with lupus from before they become pregnant through delivery to spot fetuses at high risk and allow for early delivery.
Read more about work by members of LRA’s Scientific Advisory Board Drs. Virginia Pascual and Jane Salmon that may raise the odds of successful pregnancies.