Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


High Prevalence of Fetal Loss and Pregnancy Complications in African-American Lupus Patients: A Retrospective Case-Control Study.

Eddleman2,  Kirk C., Majithia1,  Vikas

University of Mississippi Medical Center, Jackson, MS
University of Mississippi Medical Center

Introduction:

Pregnancy in Systemic Lupus Erythematosus (SLE) patients is associated with a high rate of fetal loss and pregnancy complications which are about 2–4 times higher than non-SLE patients. The rates are felt to be even higher in African-American (AA) patients, but an exact prevalence and risk is not yet characterized. We undertook this study to assess the risk of fetal loss and complications in SLE patients at University of Mississippi Medical Center, caring for predominantly (gt]90%) AA patients.

Methods:

A retrospective chart review of pregnancies in 83 women with SLE and 99 age-matched controls was performed for time-period between 2004 and 2006. Patients were identified by cross referencing billing codes 710.0 (Lupus) and 648.1 or 648.3 (Pregnancy). Data included: demographics, SLE related information, medications, compliance with follow-up visits (>60%), fetal outcomes and complications. Odds ratio were calculated and statistical significance was determined using Fischer's Exact test.

Results:

Mean age of two groups were 22 years and both groups had 95 % AA patients. Results are summarized below.

Table 1. Fetal loss in SLE versus non-SLE patients

 SLE groupControl groupOdds ratioP-value
Overall Fetal Loss16.9% (n=83)3% (n=99)6.490.001
Overall Fetal loss in hydroxycholoroquine users6% (n=30)3% (n=99)2.28NS
Overall Fetal loss in compliant patients*3% (n=67)1% (n=54)1.6NS
(*compliance=> 60% follow-up visits).

Table 2. Maternal Complications in pregnancy for SLE versus non-SLE patients

 SLE groupControl groupOdds ratioP-value
Pre-term Labor50.7%31.2%2.260.01
Baseline Hypertension33.7%9%5.09<0.0001
Pre-Eclampsia31.3%18.2%2.050.04
HELLP Syndrome*6%2%3.10NS
Hyperglycemia2%3%NSNS
(HELLP=Hypertension, Elevated Liver enzymes and Low platelets)

Discussion:

We found SLE significantly increased the risk of fetal loss in 2nd and 3rd trimesters (OR 6.49). The risk was similarly increased in this study for miscarriage (fetal loss<20 weeks) and stillbirth (fetal loss>20 weeks). In contrast, patients who were being treated with hydroxychloroquine (OR 2.28) or were compliant (OR 1.6) only had a minor increase in the risk as compared to control group. SLE patients had increased likelihood of having baseline hypertension, pre-eclampsia and pre-term labor. There was no increase in likelihood of association with hyperglycemia, C-sections, HELLP syndrome, anti-phospholipid antibodies or lupus activity markers in our comparison.

Our data suggest the likelihood of the fetal loss (6 vs 4 times), any complication (80% vs 50%), pre-eclampsia(33% vs 20%) or pre-term labor (50% vs 33%) may be higher than previously reported. The AA ethnicity may be a contributing factor here but a small sample size limits further characterization of the specific factors contributing to the increased risk.

Conclusion:

There is a marked increase in risk of fetal loss and adverse pregnancy complications in African-American SLE patients many of which are higher than previously reported. Plaquenil and compliance with physician care seem to help decrease the likelihood of these adverse outcomes.

To cite this abstract, please use the following information:
Eddleman, Kirk C., Majithia, Vikas; High Prevalence of Fetal Loss and Pregnancy Complications in African-American Lupus Patients: A Retrospective Case-Control Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1860
DOI: 10.1002/art.29625

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