New Data on Lupus Disease Activity and Maternal and Fetal Health Risks during Pregnancy
A newly published study finds that women in India with lupus have a low risk of experiencing a major flare (i.e., significant disease activity) during their pregnancy when conception happens during a time of disease stability. Only about 4% of women with previously well-controlled disease had a major flare while pregnant. Use of the medication hydroxychloroquine (also known as Plaquenil) was also associated with decreased risk of disease flares during pregnancy in women in remission at the time of conception.
The study assessed 121 pregnancies in 80 Indian women with lupus, most of whom were in clinical remission. About one-third (32%) of the women enrolled in the study experienced maternal complications during pregnancy – most commonly, hypertensive (high blood pressure) disorders of pregnancies, or HPD. HPD is a risk factor independent of lupus disease activity, and it is strongly associated with poor fetal outcomes, particularly stillbirth, prematurity and need for caesarean section.
Overall, more than half (58%) of the pregnancies resulted in poor fetal outcomes. Of the 121 pregnancies studied, 16% ended in first-trimester miscarriage, 11.6% resulted in stillbirth and 20% were characterized by premature birth. Testing positive for lupus anticoagulant (LA – an autoantibody associated with excess blood clotting) was associated with first-trimester miscarriages in women in remission. Fewer than half (46.8%) of the women who conceived while their lupus was in remission experienced poor fetal outcomes, and the researchers found that disease activity during conception was associated with a three-fold increased risk of adverse fetal outcomes.
This study was the first of its kind in India. Since risk of pregnancy complications and lupus flares partly depends on the population studied, these latest findings add important new insights into maternal and fetal health risks among women with lupus around the world. While the researchers found some results were similar to those reported in other countries and ethnic groups, they also observed the rate of stillbirth among the Indian cohort was actually higher compared to those found in the U.S. and China.
Study author Dr. Vineeta Shobha offers a message to lupus warriors, “Pregnancy is precious. For the best outcome, preplan pregnancy in consultation with you doctor when (your) lupus (disease) is stable and you are on treatment with safe medications. Hydroxychloroquine use keeps you and baby safe. Planning is the key to success!”
Learn about planning a pregnancy when you have lupus.