Lupus Linked To Higher Risk of Pregnancy and Neonatal Complications

MedicalResearch.com Interview with:
Dr. Julia Fridman Simard ScD Assistant Professor Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Division of Epidemiology, Department of Health Research & Policy Division of Immunology & Rheumatology, Department of Medicine Stanford School of Medicine
Dr. Julia Fridman Simard ScD
Assistant Professor
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
Division of Epidemiology, Department of Health Research & Policy
Division of Immunology & Rheumatology, Department of Medicine
Stanford School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Simard: A number of studies have shown that women with lupus who get pregnant have more complications and adverse outcomes, although the methodologies across studies vary considerably. Using population-based data we were able compare the occurrence of these pregnancy complications in mothers with lupus to pregnancies from the general population. We were also interested in whether women in our data set who first presented with lupus up to five years post-partum had more pregnancy-related adverse events. Our descriptive study showed that preterm delivery, infant infection, and preeclampsia were more common in the first singleton pregnancies of women with lupus compared to the general population. These outcomes were also observed more often among women who appeared to present with lupus up to five years post-partum.

Medical Research: What should clinicians and patients take away from your report?

Dr. Simard: The present study included decades worth of data from large population-based registers, presented descriptively, but does not focus exclusively on the contemporary patient nor on all pregnancies. The present study aimed to put the occurrence of these outcomes into context of a background risk from the general population and found that women with mothers with lupus had more adverse outcomes during pregnancy and the post-partum period, which has previously been shown. Not every women with lupus is at the same risk for adverse outcomes and the present study did not identify specific risk factors for poor pregnancy outcomes.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Simard: The clinical picture of pregnancy in lupus has been evolving and our study looks collectively at the experience in one country since 1987. Future research should focus on the complications in contemporary patients and examine the role of differences in patient demographics and comorbidities, lupus disease manifestations, and management. We also need to look more closely at each of these poor outcomes to consider what factors are increasing the risk of specific problems, in women with lupus, such as preeclampsia or preterm birth, as well as investigate what happens in subsequent pregnancies. Additionally, a closer look at the pre-SLE pregnancy population is important to better establish temporality of events. And lastly, although much of the focus has been on complications to the mother or the pregnancy, future research should also investigate the consequences to the children and what factors influence those risks.

Citation:

What to expect when expecting with SLE: A population-based study of maternal and fetal outcomes in SLE and pre-SLE

Elizabeth V. Arkema post-doctoral scholar Kristin Palmsten post-doctoral scholar Christopher Sjöwall associate professor Elisabet Svenungsson associate professor, Jane E. Salmon professor5 and Julia F. Simard

Arthritis Care and Research DOI: 10.1002/acr.22791

Dr. Julia Fridman Simard (2016). Lupus Linked To Higher Risk of Pregnancy and Neonatal Complications