In the European Congress of Rheumatology 2022 (EULAR 2022) on the hemophilia management, Dr. Bella Mehta from the Hospital for SpecialSurgery of New York, the United States (US), presented her study onthe fetal and maternal morbidity in systemic lupus erythematosus (SLE)deliveries compared with non-SLE deliveries in the US.

SLE is an autoimmune disorder affecting women at childbearing age, leading to increased maternal morbidity and mortality in the US.¹ Across-sectional analysis examined the trends in maternal and fetal outcomes among pregnant SLE women in the US over the past 15 years, revealing that in-hospital maternal and fetal mortality in SLE patients was higher than that in non-SLE patients, but has declined over the past years.¹ Given the lack of recent data on morbidity in these patients, Dr. Mehta and her colleagues conducted a nationwide study in the US to determine the proportion of fetal and maternal morbidity in SLE deliveries compared with non-SLE deliveries over a decade.¹

More than 40,000,000 retrospective data from the NationalInpatient Sample database were used to identify delivery-related hospital admissions between 2008 to 2017, using the international classification of Diseases (ICD) 9 and 10 codes.1 Of these patients,51,161 had SLE.¹ SLE patients were slightly older at the time of delivery compared with non-SLE patients (mean age, 30.05 vs. 28.19 years).¹Most SLE patients (97.84%) had a higher score of 1-4, indicating increased comorbidities; while most non-SLE patients (80.56%) had an Elixhauser Comorbidity Index of 0.¹

The indicators of fetal morbidity were preterm delivery and intrauterine growth restriction, whereas those of maternal morbidity were 21 indicators defined by the Centers for Disease Control and Prevention (CDC), which were unexpected outcomes of labor and delivery, resulting in significant short- or long-term consequences to women’s health.¹

Compared with non-SLE patients, maternal morbidity indicators ofblood transfusions during or around pregnancy (1.1.% vs. 4%), acuterenal failure (0.1% vs. 1.5%), cerebrovascular disorders (1.1% vs.4.8%), eclampsia and disseminated intravascular coagulation (DIC)(0.4% vs. 1.3%), cardiovascular and peripheral vascular disorders(0.1% vs. 1.1%), medical issues (0.5% vs. 1.8%) were more commonamong SLE patients.¹ Similarly, the fetal morbidity indicators werealso higher among SLE patients.¹

Dr. Mehta pointed out the limitations of the study, including the inability to incorporate outpatient deliveries accounting for 1.3% ofall deliveries, and the potential misclassification of diagnosis due to billing information and discharge diagnosis.¹ Moreover, the data did not include SLE factors, such as disease activity, the APGAR scores(which measure appearance, pulse, grimace response, activity and respiration), flares, the presence of nephritis, antiphospholipid or anti-Sjögren's-syndrome-related antigen A autoantibodies (anti-Ro/SSA antibodies) antibodies, and medications.¹

In conclusion, SLE patients tend to experience higher rates of fetal morbidity and severe maternal morbidity compared with non-SLE patients.¹ Pregnant SLE patients are more likely to develop a cerebrovascular disorder or acute renal failure, or experience intrauterine growth restriction, and require a transfusion or deliver prematurely.¹ This study highlighted the importance of counseling SLE patients during pregnancy, also providing insight into the management of these patients.¹