medwireNews: African–American women with systemic lupus erythematosus (SLE) have an increased risk for delivering preterm or small for gestational age (SGA) infants, even in the years immediately before their diagnosis, US study findings indicate.
“As the prognosis for women diagnosed with SLE improves, more women with SLE will likely pursue pregnancy and childbearing,” write Meghan Angley (Emory University, Atlanta, Georgia) and co-authors in Arthritis Care & Research.
They believe: “Healthcare providers, especially those in communities of color should be better educated about SLE, and have a lower threshold to suspect SLE in the peripartum period.”
Angley and team analyzed data for 583 births to African–American women with SLE who were identified from the Georgia Lupus Registry and the Georgians Organized Against Lupus Cohort and compared outcomes with those of 11,660 births to African–American women in the general population of metropolitan Atlanta.
The highest proportion (40.8%) of births among women with SLE occurred more than 3 years before diagnosis, with the remaining 17.5%, 13.6%, and 28.1% occurring 0–3 years before diagnosis, 0–3 years after diagnosis, and more than 3 years after diagnosis, respectively.
The researchers found that, overall, the preterm (<37 weeks’ gestation) birth rate was nearly twice as high among the women with versus without SLE (28.5 vs 15.5%).
After adjustment for maternal age, education, and parity, women with SLE had a significant 1.71-fold higher risk for preterm birth in the 0–3 years prior to diagnosis than women without SLE. The risk was a significant 2.29-fold higher for women who gave birth 0–3 years after SLE diagnosis and a significant 2.83-fold higher for women who were 3 or more years post-SLE diagnosis. There was no increased risk for preterm birth among women who gave birth 3 or more years prior to being diagnosed with SLE.
The overall rates of SGA (<10th percentile) births were also twofold higher among the women with versus without SLE (18.5 vs 9.9%) and the investigators observed a similar pattern of increased risk after adjustment for potential confounders.
Specifically, there was no increased risk for SGA among women who gave birth 3 or more years before SLE diagnosis relative to women without SLE, but those who gave birth in the 3 years preceding diagnosis were a significant 2.38 times more likely to have SGA infants. The relative risk increased to a significant 2.89-fold when births occurred in the 3 years after SLE diagnosis and then fell slightly, to a significant 2.28-fold, among births occurring more than 3 years after diagnosis.
Angley et al conclude: “Our results suggest that African American women with SLE are at greater risk for the adverse outcomes preterm birth and SGA than the general population of African American women, even before a clinical diagnosis of SLE.”
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