INTRODUCTION
Women with systemic lupus erythematosus have a higher chance of some kinds of problems during pregnancy. But most women who have problems with their first pregnancy, even stillbirth, have a second pregnancy without health problems.
WHAT DO WE KNOW ALREADY?
Lupus is an autoimmune disease, which means it causes problems with the immune system. This can cause health problems affecting the heart, kidneys, and skin. There are different types of lupus illnesses, and one called systemic lupus erythematosus (SLE) can affect any part of the body. It most often affects women of childbearing age. Compared to women in the general population,
women with SLE, especially those with involvement of the kidney, are 1.5–3 times more likely to have high blood pressure during their pregnancy, to need hospital treatment while pregnant, to have an unplanned caesarean section, or have a stillborn child.
There have been studies that have looked at what happens to women with SLE who are having their first baby. But there’s less information about women with SLE who go on to have a second baby, especially if they had problems during their first pregnancy. This information could be useful for women with SLE who are deciding whether to try and get pregnant for a second time.
To find out more, researchers in Australia looked at the medical records of women who gave birth in the New South Wales region between 2001 and 2008. They recorded, for women with and without SLE, how many women had complications or problems during their second pregnancy. In particular, they looked at how
many women whose first baby was either stillborn or who died in the first 28 days after birth, went on to have problems in their second pregnancy.
WHAT DOES THE NEW STUDY SAY?
Women with SLE were more likely than women in the general population to have some kinds of health problems during their second pregnancy or labour. These problems included bleeding during birth and blood clots. About 11 in 100 women with SLE who had had a successful first pregnancy had a miscarriage from 20
weeks onward. This compares with less than 1 in 100 in the general population.
Overall for women with SLE:
- Around 69 in 100 women who had a first pregnancy went on to have a second. This is around the same as
in the general population. - Around 5 in every 100 women who were pregnant with their first child had a baby who was either stillborn
or who died during the first 28 days after birth. This was around three times higher than women in the
general population. - Less than 1 in 100 women who had a second pregnancy had a baby who was either stillborn or died in the
first 28 days after birth. - Around 90 in 100 women whose first baby was either stillborn or who died within the first 28 days after
birth went on to have a baby who survived and was able to go home as normal.
HOW RELIABLE ARE THE FINDINGS?
The researchers used reliable medical records for women with and without SLE. But although the researchers had accurate records about what happened to women with SLE once they became pregnant, they didn’t have information about how their illness was treated. Women with SLE whose symptoms are under good control are less likely to have problems if they become pregnant than women whose SLE is less well controlled. The researchers weren’t able to adjust their figures to account for this.
The researchers only had information about women who had miscarriages that were recorded in their medical records, and no information about women who had a miscarriage before their 20th week of pregnancy. This missing information may have affected the results.
WHAT DOES THIS MEAN FOR ME?
This study supports previous findings that women with SLE are more likely to have problems during their pregnancy than women in the general population. These problems can include things that can be treated, but can also include stillbirth and a baby who dies early. However, this study also shows that most women with SLE who decide to have a second baby won’t have the same problems again. The authors say that, for women with SLE, as for women who don’t have health problems, once a baby goes home from hospital, their outlook is generally favourable.
WHAT SHOULD I DO NOW?
Women with SLE often see a specialist hospital doctor to help them manage their illness. If you have SLE and are considering trying to get pregnant, you can discuss with your doctor and medical team what might happen, and what you can do to best manage your health and reduce your chances of complications during pregnancy
and birth.
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Date summary prepared: June 2013
Summary based on research article published on: 29 June 2012
From: Shand, A. et al. Second pregnancy outcomes for women with systemic lupus erythematosus. Ann Rheum Dis 2013;72:547-551 doi:10.1136/annrheumdis-2011-201210
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