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 AffiliationsFunding 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.
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.
1
Molokhia M,
Maconochie N,
Patrick AL,
Doyle P.
Cross-sectional analysis of adverse outcomes in 1,029 pregnancies of Afro-Caribbean women in Trinidad with and without systemic lupus erythematosus. Arthritis Res Ther 2007; 9 (06) R124
2
Yan Yuen S,
Krizova A,
Ouimet JM,
Pope JE.
Pregnancy outcome in systemic lupus erythematosus (SLE) is improving: results from a case control study and literature review. Open Rheumatol J 2008; 2: 89-98
4
Barnabe C,
Faris PD,
Quan H.
Canadian pregnancy outcomes in rheumatoid arthritis and systemic lupus erythematosus. Int J Rheumatol 2011; 2011: 345727
5
Arkema EV,
Palmsten K,
Sjöwall C,
Svenungsson E,
Salmon JE,
Simard JF.
What to expect when expecting with systemic lupus erythematosus (SLE): a population-based study of maternal and fetal outcomes in SLE and Pre-SLE. Arthritis Care Res (Hoboken) 2016; 68 (07) 988-994
6
Wei S,
Lai K,
Yang Z,
Zeng K.
Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies. Lupus 2017; 26 (06) 563-571
9 Socialstyrelsen. Kvalitet och innehåll i patientregistret (Quality and Contents of the Patient Register) - Utskrivningar från slutenvården 1964–2007 och besök i specialiserad öppenvård (exklusive primärvårdsbesök) 1997–2007
10
Epidemiology Cf.
The Swedish Medical Birth Register - A Summary of Content and Quality. Stockholm, Sweden: The National Board of Health and Welfare; 2003
11
Bundhun PK,
Soogund MZ,
Huang F.
Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: a meta-analysis of studies published between years 2001-2016. J Autoimmun 2017; 79: 17-27
12
Clowse ME,
Jamison M,
Myers E,
James AH.
A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008; 199 (02) 127.e1-127.e6
13
Palmsten K,
Hernández-Díaz S,
Kuriya B,
Solomon DH,
Setoguchi S.
Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia. Arthritis Care Res (Hoboken) 2012; 64 (11) 1730-1738
16
Arkema EV,
Jönsen A,
Rönnblom L,
Svenungsson E,
Sjöwall C,
Simard JF.
Case definitions in Swedish register data to identify systemic lupus erythematosus. BMJ Open 2016; 6 (01) e007769
19
Leroux M,
Desveaux C,
Parcevaux M.
, et al. Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus 2015; 24 (13) 1384-1391