Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades
Objective Using a large, de‐identified electronic health record database with over 3.2 million patients, we aimed to identify trends of systemic lupus erythematosus (SLE) medication use during pregnancy and birth outcomes from 1989 to 2020. Methods Using a previously validated algorithm for SLE deli...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-08-01
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| Series: | ACR Open Rheumatology |
| Online Access: | https://doi.org/10.1002/acr2.11447 |
| _version_ | 1828183716463116288 |
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| author | April Barnado Janie Hubbard Sarah Green Alex Camai Lee Wheless Sarah Osmundson |
| author_facet | April Barnado Janie Hubbard Sarah Green Alex Camai Lee Wheless Sarah Osmundson |
| author_sort | April Barnado |
| collection | DOAJ |
| description | Objective Using a large, de‐identified electronic health record database with over 3.2 million patients, we aimed to identify trends of systemic lupus erythematosus (SLE) medication use during pregnancy and birth outcomes from 1989 to 2020. Methods Using a previously validated algorithm for SLE deliveries, we identified 255 pregnancies in patients with SLE and 604 pregnancies in controls with no known autoimmune diseases. We examined demographics, medications, SLE comorbidities, and maternal and fetal outcomes in SLE and control deliveries. Results Compared with control deliveries, SLE deliveries were more likely to be complicated by preterm delivery (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 4.31‐10.55; P < 0.001) and preeclampsia (OR: 3.22; 95% CI: 1.83‐5.66; P < 0.001) after adjusting for age at delivery, race, and parity. In a longitudinal analysis, medication use during SLE pregnancies remained relatively stable, with some increased use of hydroxychloroquine over time but no increase in aspirin use. For SLE deliveries, preterm delivery and preeclampsia rates remained stable. Conclusion We observed rates of preeclampsia and preterm delivery in SLE that were five times higher than the general population and higher compared with other prospective SLE cohorts. Furthermore, we did not observe improved outcomes over time with preeclampsia and preterm delivery. Despite increasing evidence for universal use of hydroxychloroquine and aspirin, we did not observe substantially higher use of these medications over time, particularly for aspirin. Our results demonstrate the continued need to prioritize educational and implementation efforts to improve adverse pregnancy outcomes in SLE. |
| first_indexed | 2024-04-12T06:35:40Z |
| format | Article |
| id | doaj.art-4333aa7ff57b49fdaa891ffdc4b51bd7 |
| institution | Directory Open Access Journal |
| issn | 2578-5745 |
| language | English |
| last_indexed | 2024-04-12T06:35:40Z |
| publishDate | 2022-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ACR Open Rheumatology |
| spelling | doaj.art-4333aa7ff57b49fdaa891ffdc4b51bd72022-12-22T03:43:52ZengWileyACR Open Rheumatology2578-57452022-08-014871172010.1002/acr2.11447Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three DecadesApril Barnado0Janie Hubbard1Sarah Green2Alex Camai3Lee Wheless4Sarah Osmundson5Vanderbilt University Medical Center Nashville TennesseeVanderbilt University Medical Center Nashville TennesseeVanderbilt University Medical Center Nashville TennesseeVanderbilt University Medical Center Nashville TennesseeVanderbilt University Medical Center Nashville TennesseeVanderbilt University Medical Center Nashville TennesseeObjective Using a large, de‐identified electronic health record database with over 3.2 million patients, we aimed to identify trends of systemic lupus erythematosus (SLE) medication use during pregnancy and birth outcomes from 1989 to 2020. Methods Using a previously validated algorithm for SLE deliveries, we identified 255 pregnancies in patients with SLE and 604 pregnancies in controls with no known autoimmune diseases. We examined demographics, medications, SLE comorbidities, and maternal and fetal outcomes in SLE and control deliveries. Results Compared with control deliveries, SLE deliveries were more likely to be complicated by preterm delivery (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 4.31‐10.55; P < 0.001) and preeclampsia (OR: 3.22; 95% CI: 1.83‐5.66; P < 0.001) after adjusting for age at delivery, race, and parity. In a longitudinal analysis, medication use during SLE pregnancies remained relatively stable, with some increased use of hydroxychloroquine over time but no increase in aspirin use. For SLE deliveries, preterm delivery and preeclampsia rates remained stable. Conclusion We observed rates of preeclampsia and preterm delivery in SLE that were five times higher than the general population and higher compared with other prospective SLE cohorts. Furthermore, we did not observe improved outcomes over time with preeclampsia and preterm delivery. Despite increasing evidence for universal use of hydroxychloroquine and aspirin, we did not observe substantially higher use of these medications over time, particularly for aspirin. Our results demonstrate the continued need to prioritize educational and implementation efforts to improve adverse pregnancy outcomes in SLE.https://doi.org/10.1002/acr2.11447 |
| spellingShingle | April Barnado Janie Hubbard Sarah Green Alex Camai Lee Wheless Sarah Osmundson Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades ACR Open Rheumatology |
| title | Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades |
| title_full | Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades |
| title_fullStr | Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades |
| title_full_unstemmed | Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades |
| title_short | Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades |
| title_sort | systemic lupus erythematosus delivery outcomes are unchanged across three decades |
| url | https://doi.org/10.1002/acr2.11447 |
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