LONDON – Women with both rheumatoid arthritis and systemic lupus erythematosus were more than twice as likely as women without these diseases to have pregnancy-related hypertension, and the risk has not lessened in recent years despite improved treatment, according to 10-years’ worth of admission and discharge data from several Canadian hospitals.
Such women were more likely to undergo a cesarean section, and their newborns were more likely to be born prematurely, be small for gestational age (SGA), and require intensive care, compared with children born to women without RA or SLE.
"We wanted to look at what obstetrical and neonatal outcomes have been like over the past 10 years in both RA and in lupus," study author and rheumatologist Dr. Cheryl Barnabe said in an interview during a poster session at the annual European Congress of Rheumatology.
To do so, Dr. Barnabe and colleagues used an administrative database maintained by the Canadian government to examine the outcomes of 38 women with RA and 95 with SLE who were admitted and discharged from hospitals in Calgary for obstetric reasons. Outcomes were compared with expectant women who did not have either condition, with four times as many controls as cases.
"We found that the RA and lupus patients stayed in hospital longer [after delivery], approximately double the percentage of patients [in both groups] had C-sections done, and there were more postpartum infections in the lupus patients compared to the lupus controls [6.3% vs. 1.3%, P less than .004]," observed Dr. Barnabe, a clinical scholar in the department of medicine at the University of Calgary in Alberta.
Adjusted odds ratios (ORs) for preeclampsia or eclampsia were 2.8 (95% confidence interval 1.0-7.8) for RA and 2.0 (95% CI 1.0-3.7) for SLE.
The mean length of hospital stay was 0.9 days longer for women with RA than for those without (P less than .003) and 1.8 days longer for those with SLE than for those without (P less than .001).
One-third (34.2%) of women with RA and 43.2% of women with SLE underwent cesarean section compared with 21.2% of RA controls and 23.7% of SLE controls. The adjusted ORs for cesarean section in RA and SLE were 2.3 (95% CI 0.9-4.7) and 2.8 (95% CI 1.5-4.0), respectively.
Babies were more frequently premature, with 2.6% vs. 0.7% born between 28 and 34 weeks’ gestation in women with and without RA, and 18.4% vs. 8% born at 34-37 weeks’ gestation. Corresponding values for the children of women with SLE were 8.4% vs. 1.9% at 28-34 weeks and 23.2% vs. 5.1% at 34-37 weeks. Three (3.2%) women with SLE but none without gave birth at less than 28 weeks’ gestation.
The adjusted ORs for premature delivery were 2.7 (95% CI 1.0-7.0) for RA and 6.6 (95% CI 3.5-12.3) for SLE.
Not surprisingly, the need for intensive care was higher among children born to women with RA or SLE than among the babies of women in the control groups. Adjusted ORs for SGA were 3.0 and 2.8 for RA and SLE, respectively.
These findings suggest the need for improved multidisciplinary management of women with arthritic conditions who are pregnant, Dr. Barnabe suggested.
"I think this shows that we can’t just assume that if we treat disease activity well enough we will affect obstetrical outcomes," she said.
"We should liaise with the obstetricians and the maternal-fetal medicine specialists and others to ensure that blood pressures are well controlled during pregnancy and make sure the disease activity is well controlled, and that will hopefully optimize these outcomes," Dr. Barnabe added. "I think a combined clinic is probably the best way to approach this."
Dr. Barnabe disclosed receiving a scholarship from the Arthritis Society, UCB, and the Canadian Rheumatologists Association for her master’s degree. A coauthor has received financial support from Alberta Innovative Health Solutions.