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Am J Perinatol 2019; 36(09): 964-968
DOI: 10.1055/s-0038-1675648
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preterm Delivery Phenotypes in Systemic Lupus Erythematosus Pregnancies

Julia F. Simard
1   Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
2   Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
3   Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
,
Yashaar Chaichian
2   Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
,
Marios Rossides
3   Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
,
Anna-Karin Wikstrom
3   Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
4   Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
,
Gary M. Shaw
5   Division of Neonatology and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California
,
Maurice L. Druzin
6   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
› Author Affiliations Funding J.F.S. is supported by the National Institutes of Health's National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant K01-AR066878). A.K.W. is supported by the Swedish Research Council (grant no 2014–3561). Y.C. receives partial salary support through the Dr. Elaine Lambert Lupus Fellowship through the John & Marcia Goldman Foundation. Partial support for M.L.D. and G.M.S. were provided by the March of Dimes Prematurity Research Center at Stanford University.
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Publication History

25 January 2018

02 October 2018

Publication Date:
26 November 2018 (online)

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Abstract

Objective Women with systemic lupus erythematosus (SLE) are at a greater risk of preterm delivery, many of which may be medically indicated (iatrogenic). We investigated preterm delivery phenotypes in SLE and general population comparators and assessed the role of preeclampsia.

Study Design We used population-based Swedish Register data (2001–2013) and defined maternal SLE as ≥2 SLE-coded discharge diagnoses from the Patient Register with ≥1 coded by an appropriate specialist. Women from the general population were identified using the Total Population Register. Preterm delivery was defined as <37 weeks and separated into spontaneous and iatrogenic, as well as later versus extremely preterm (32 to <37 weeks vs. <32 weeks). Maternal comorbidity was assessed, and the proportion mediated by preeclampsia was calculated examining first, subsequent, and all pregnancies.

Results Preterm delivery was more common in SLE for the first (22 vs. 6%) and subsequent (15 vs. 4%) pregnancies among 781 SLE-exposed pregnancies and 11,271 non-SLE pregnancies. Of SLE-exposed first births, 27% delivered before 32 weeks, and 90% were iatrogenic (compared with 47% of non-SLE first births).

Conclusion Preterm delivery complicates a greater proportion of SLE pregnancies than general population pregnancies, and a considerable proportion of risk is mediated through preeclampsia.

Keywords

lupus - preterm birth - registers - preeclampsia

Supplementary Material