Sep. 18, 2012

Second Pregnancy Outcomes in Lupus

Second pregnancy outcomes for women with systemic lupus erythematosus
Shand AW, Algert CS, March L, and Roberts CL. (2012). Annals of the Rheumatic Diseases. 2012 June 29. [Epub ahead of print]

What is the topic?

Women with lupus are at increased risk of pregnancy-related complications, such as higher rates of pre-eclampsia, gestational hypertension, eclampsia, and lupus flares. These women may also have higher rates of caesarean section, hospital admission, and length of hospital stay. However, second pregnancy outcomes in women with lupus have not been reported.

What did the researchers hope to learn?

The researchers hoped to learn about second pregnancy outcomes in women with systemic lupus erythematosus, particularly in those who had a first pregnancy adverse outcome.

Who was studied?

The study analyzed data obtained from two linked databases containing medical records of 794,577 deliveries from 532,612 women who gave birth in New Wales, Australia from 2001 - 2009.

How was the study conducted?

Data was obtained from two longitudinally linked databases containing medical records of all women giving birth in New Wales, Australia from 2001-2009. These medical records included information about whether or not a woman was diagnosed with lupus, or experienced one of the following pregnancy-related complications: spontaneous abortion, stillbirth, neonatal death, perinatal death, potential nephritis, pre-eclampsia, kidney biopsy, kidney failure (or dialysis), hypertension, diabetes, obstetric hemorrhage or thrombotic event, and blood transfusion. The following data were also obtained from the medical records: gestational age at delivery, infant birth weight, and small for gestational age. The relationships between lupus, maternal, and pregnancy-related factors were determined as relative risk.

What did the researchers find?

From 2001-2009, there were 1,058 deliveries to 675 women with lupus in New Wales, Australia. Of these, 177 had a second birth during the study period. Of them, 10 women had a stillbirth or neonatal death in their first pregnancy; 90% (9 out of 10) of these women had a live-born infant with their second pregnancy. Among the 167 mothers whose firstborn was discharged home alive, there was only one stillbirth and no neonatal deaths in the second pregnancy. However, 11% terminated in spontaneous abortions. The persistence or recurrence of (presumably lupus-related) kidney involvement in a second pregnancy was common, but significantly more common among women with lupus who did not go on to have a second pregnancy.

What were the limitations of the study?

Detailed information about drug treatments for lupus was not available for the women included in this study. In addition, the current study did not capture information about kidney disease, hypertension, lupus disease activity, or the presence of anti-phospholipid antibodies among the women with lupus upon entry to the study.

What do the results mean for you?

The results of this study indicate that a second pregnancy in lupus patients who have had a neonatal death or stillbirth with their first pregnancy, had a good outcome, with 90% having a live-born second infant. However, among the women who had a good first pregnancy outcome, spontaneous abortion occurred in 11% of them. Therefore, women with lupus whose first pregnancy resulted in perinatal death can have reasonable expectations of a live birth in their second pregnancy.

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