Thrombocytopenia Ups Preeclampsia Risk in SLE

SAN FRANCISCO — The risk for preeclampsia in pregnant women with lupus tripled if they had thrombocytopenia at conception, according to a review of data from a 10-year period at one institution.

This previously unreported finding was highly statistically significant, but prospective studies will be needed to confirm the association, study investigator Maurice L. Druzin, M.D., said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

“We certainly are going to be looking at patients with thrombocytopenia very closely,” said Dr. Druzin, professor of ob.gyn. and chief of maternal and fetal medicine at Stanford (Calif.) University.

The review of all pregnancies complicated by systemic lupus erythematosus seen at the university from 1991 to 2001 covered 63 pregnancies in 48 patients with a mean maternal age of 30 years. Lupus had been present for a mean of 4 years in these patients, and the disease was active at conception in 63% of pregnancies. As a group, these were sicker patients than those usually seen by an ob.gyn.

Preeclampsia occurred in 22% of all pregnancies. Thrombocytopenia at conception predicted the development of preeclampsia, according to multivariate analyses to identify clinical predictors of prematurity and preeclampsia.

Gestational diabetes occurred in 5% of pregnancies, and 4% of the cohort developed hemolysis, elevated liver, low platelet (HELLP) syndrome.

Among the pregnancies with active maternal lupus at conception, treatments included prednisone in 48%, hydroxychloroquine in 21%, and antihypertensives in 13%.

Maternal antiphospholipid antibodies were detected in about half of all pregnancies. The cohort had a higher likelihood of having anti-Ro/SSA or anti-La/SSB antibodies than generally is seen in patients with lupus—38% vs. 25%—again emphasizing the select nature of this referral population. Maternal renal disease was present in 35% of pregnancies, and maternal CNS disease affected 10% of pregnancies.

Despite this, birth outcomes were “very good,” with 54 live births, Dr. Druzin said. “When a woman with lupus comes to you, you can tell her that she has a very good chance of having a live birth, which was not true 25 years ago.” The remaining pregnancies ended in first-trimester losses or therapeutic abortions.

As in other studies of pregnancy and lupus, premature delivery was the main fetal problem, occurring n 54% of pregnancies. However, 46% of these were delivered at 32–37 weeks' gestation. “In modern intensive care units, those babies tend to do very well,” he said. An additional 4% were born at 28–32 weeks, and 4% were delivered earlier than 28 weeks.

Lupus flares occurred in 68% of pregnancies. Of these, 71% were mild to moderate flares and were treated with 4–20 mg of additional prednisone. The risk for flare nearly doubled if lupus was active at conception. Prednisone use at conception predicted a 57% increased risk of flare, and a higher disease activity index score predicted a 56% increased risk for flare.

A severe flare was associated with nearly a doubling in risk for premature delivery. Maternal use of antihypertensives or prednisone at conception was associated with an 83% or 77% increase, respectively, in risk for premature birth.

Among 13 women on hydroxychloroquine at conception, severe flares occurred in 2 of 11 women who stopped taking the medication after conception but not in women who continued treatment or stopped before conception, he noted. This difference was not significant, but the finding plus other data suggest that hydroxychloroquine is safe to use in pregnancy.

The review will be published in the American Journal of Obstetrics and Gynecology. The lead author of the paper is Eliza F. Chakravarty, M.D., a rheumatology fellow at Stanford University.

SAN FRANCISCO — The risk for preeclampsia in pregnant women with lupus tripled if they had thrombocytopenia at conception, according to a review of data from a 10-year period at one institution.

This previously unreported finding was highly statistically significant, but prospective studies will be needed to confirm the association, study investigator Maurice L. Druzin, M.D., said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

“We certainly are going to be looking at patients with thrombocytopenia very closely,” said Dr. Druzin, professor of ob.gyn. and chief of maternal and fetal medicine at Stanford (Calif.) University.

The review of all pregnancies complicated by systemic lupus erythematosus seen at the university from 1991 to 2001 covered 63 pregnancies in 48 patients with a mean maternal age of 30 years. Lupus had been present for a mean of 4 years in these patients, and the disease was active at conception in 63% of pregnancies. As a group, these were sicker patients than those usually seen by an ob.gyn.

Preeclampsia occurred in 22% of all pregnancies. Thrombocytopenia at conception predicted the development of preeclampsia, according to multivariate analyses to identify clinical predictors of prematurity and preeclampsia.

Gestational diabetes occurred in 5% of pregnancies, and 4% of the cohort developed hemolysis, elevated liver, low platelet (HELLP) syndrome.

Among the pregnancies with active maternal lupus at conception, treatments included prednisone in 48%, hydroxychloroquine in 21%, and antihypertensives in 13%.

Maternal antiphospholipid antibodies were detected in about half of all pregnancies. The cohort had a higher likelihood of having anti-Ro/SSA or anti-La/SSB antibodies than generally is seen in patients with lupus—38% vs. 25%—again emphasizing the select nature of this referral population. Maternal renal disease was present in 35% of pregnancies, and maternal CNS disease affected 10% of pregnancies.

Despite this, birth outcomes were “very good,” with 54 live births, Dr. Druzin said. “When a woman with lupus comes to you, you can tell her that she has a very good chance of having a live birth, which was not true 25 years ago.” The remaining pregnancies ended in first-trimester losses or therapeutic abortions.

As in other studies of pregnancy and lupus, premature delivery was the main fetal problem, occurring n 54% of pregnancies. However, 46% of these were delivered at 32–37 weeks' gestation. “In modern intensive care units, those babies tend to do very well,” he said. An additional 4% were born at 28–32 weeks, and 4% were delivered earlier than 28 weeks.

Lupus flares occurred in 68% of pregnancies. Of these, 71% were mild to moderate flares and were treated with 4–20 mg of additional prednisone. The risk for flare nearly doubled if lupus was active at conception. Prednisone use at conception predicted a 57% increased risk of flare, and a higher disease activity index score predicted a 56% increased risk for flare.

A severe flare was associated with nearly a doubling in risk for premature delivery. Maternal use of antihypertensives or prednisone at conception was associated with an 83% or 77% increase, respectively, in risk for premature birth.

Among 13 women on hydroxychloroquine at conception, severe flares occurred in 2 of 11 women who stopped taking the medication after conception but not in women who continued treatment or stopped before conception, he noted. This difference was not significant, but the finding plus other data suggest that hydroxychloroquine is safe to use in pregnancy.

The review will be published in the American Journal of Obstetrics and Gynecology. The lead author of the paper is Eliza F. Chakravarty, M.D., a rheumatology fellow at Stanford University.

SAN FRANCISCO — The risk for preeclampsia in pregnant women with lupus tripled if they had thrombocytopenia at conception, according to a review of data from a 10-year period at one institution.

This previously unreported finding was highly statistically significant, but prospective studies will be needed to confirm the association, study investigator Maurice L. Druzin, M.D., said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

“We certainly are going to be looking at patients with thrombocytopenia very closely,” said Dr. Druzin, professor of ob.gyn. and chief of maternal and fetal medicine at Stanford (Calif.) University.

The review of all pregnancies complicated by systemic lupus erythematosus seen at the university from 1991 to 2001 covered 63 pregnancies in 48 patients with a mean maternal age of 30 years. Lupus had been present for a mean of 4 years in these patients, and the disease was active at conception in 63% of pregnancies. As a group, these were sicker patients than those usually seen by an ob.gyn.

Preeclampsia occurred in 22% of all pregnancies. Thrombocytopenia at conception predicted the development of preeclampsia, according to multivariate analyses to identify clinical predictors of prematurity and preeclampsia.

Gestational diabetes occurred in 5% of pregnancies, and 4% of the cohort developed hemolysis, elevated liver, low platelet (HELLP) syndrome.

Among the pregnancies with active maternal lupus at conception, treatments included prednisone in 48%, hydroxychloroquine in 21%, and antihypertensives in 13%.

Maternal antiphospholipid antibodies were detected in about half of all pregnancies. The cohort had a higher likelihood of having anti-Ro/SSA or anti-La/SSB antibodies than generally is seen in patients with lupus—38% vs. 25%—again emphasizing the select nature of this referral population. Maternal renal disease was present in 35% of pregnancies, and maternal CNS disease affected 10% of pregnancies.

Despite this, birth outcomes were “very good,” with 54 live births, Dr. Druzin said. “When a woman with lupus comes to you, you can tell her that she has a very good chance of having a live birth, which was not true 25 years ago.” The remaining pregnancies ended in first-trimester losses or therapeutic abortions.

As in other studies of pregnancy and lupus, premature delivery was the main fetal problem, occurring n 54% of pregnancies. However, 46% of these were delivered at 32–37 weeks' gestation. “In modern intensive care units, those babies tend to do very well,” he said. An additional 4% were born at 28–32 weeks, and 4% were delivered earlier than 28 weeks.

Lupus flares occurred in 68% of pregnancies. Of these, 71% were mild to moderate flares and were treated with 4–20 mg of additional prednisone. The risk for flare nearly doubled if lupus was active at conception. Prednisone use at conception predicted a 57% increased risk of flare, and a higher disease activity index score predicted a 56% increased risk for flare.

A severe flare was associated with nearly a doubling in risk for premature delivery. Maternal use of antihypertensives or prednisone at conception was associated with an 83% or 77% increase, respectively, in risk for premature birth.

Among 13 women on hydroxychloroquine at conception, severe flares occurred in 2 of 11 women who stopped taking the medication after conception but not in women who continued treatment or stopped before conception, he noted. This difference was not significant, but the finding plus other data suggest that hydroxychloroquine is safe to use in pregnancy.

The review will be published in the American Journal of Obstetrics and Gynecology. The lead author of the paper is Eliza F. Chakravarty, M.D., a rheumatology fellow at Stanford University.