A new study suggests that testing positive for lupus anticoagulant antibodies in the first trimester of pregnancy is the strongest predictor of pregnancy loss in women with lupus.
Close Communications with Rheumatologist Important During Pregnancy for Women with Lupus
(San Diego, California) October 29, 2013 -- The outlook for positive pregnancy outcomes for women with lupus remains bright, but data obtained from a large insurance claims database highlights the need for specific education and counseling to pregnant women with lupus as well as close collaboration between the rheumatologist and the obstetrician throughout the pregnancy. Investigators reviewed more than 10,000 insurance claims filed over a six-year period and found that women with lupus had a higher risk for complications, such as miscarriage, hypertension, preeclampsia, preterm delivery and stillbirths. The findings point to the need for close communications between the rheumatologist and the patient to monitor and identify potential lupus-related complications early and take appropriate steps to bring them under control.
Dr. Michelle Petri, Director of the Lupus Center at John Hopkins University was the study’s principal investigator. The data was presented on Tuesday in San Diego during the American College of Rheumatology Annual Scientific Meeting. The Lupus Foundation of America worked with the study’s sponsor, UCB Pharma, to design the study, which addresses an important concern among individuals most likely to develop lupus, namely young women in their childbearing years.
This study used a large health claims database of more than 10,000 records to identify pregnant women with lupus. The database was queried using medical claims codes to identify any complications that occurred during the 44 week perinatal period either to the mother or baby. Investigators identified 1,721 women with lupus who were match 1:5 to a comparison group of pregnant women who did not have lupus.
The data analysis revealed that pregnant women with lupus consumed more healthcare resources, such as doctor visits, laboratory tests, and other resources, than women in the comparison group. Pregnant women with lupus also incurred higher average medical expenses during the perinatal period, $22,000, compared to $11,000 for the women in the comparison group.
“This study helps to confirm the need for lupus disease management strategies to include reproductive health as an area of focus, before and during pregnancy. Practically speaking, both people with lupus and their care team should be discussing reproductive health issues on an ongoing basis,” said R. Paola Daly, Outcomes & Health Senior Manager, Lupus Foundation of America. “The study also reminds us that a specialized and coordinated care team can be very effective for addressing the challenges presented by pregnant women with lupus,” said Daly. While the women with lupus had higher risk for complications, the increased risk for earlier adverse pregnancy events, including miscarriage prior to 22 weeks and threatened abortion, appeared modest.
Recommendations suggest that women with lupus who want to become pregnant meet with their doctor three to six months in advance of when they plan to try to become pregnant. The best time to become pregnant is when women with lupus are doing well with their health as women whose lupus is in remission have much less trouble with pregnancy than women whose disease is active. In addition, it is important to be monitored closely by a rheumatologist and specialists in maternal-fetal medicine throughout the pregnancy.
Listen to a Podcast with Paola Daly Discussing this Study