Early‐onset Preeclampsia in Lupus Pregnancy

Abstract

Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that occurs during childbearing years and has been associated with preeclampsia. However, little is known about preeclampsia of early onset, which is associated with severe adverse maternal and perinatal outcomes. Methods Using national population-based Swedish registers we identified women with SLE (≥2 visits with corresponding ICD-codes) and a sample without SLE who gave birth to singleton infants 2001-2012. Risk ratios (RR) and 95% confidence intervals (CI) for early-onset preeclampsia (defined by ICD-codes corresponding to preeclampsia registered at <34 weeks) in SLE women were calculated based on adjusted modified Poisson models for first, subsequent, and all pregnancies. Result Among 742 births to women with SLE and 10 484 births to non-SLE women there were 32 (4.3%) and 55 (0.5%) diagnoses of early-onset preeclampsia, respectively. SLE was associated with an increased risk of early-onset preeclampsia (RR 7.8, 95% CI 4.8, 12.9, all pregnancies). The association remained similar upon restriction to women without pregestational hypertension. Adjustment for antiphospholipid syndrome (APS)-proxy attenuated the association. RRs for early-onset preeclampsia were smaller for subsequent pregnancies (RR 4.7, 95% CI 2.0, 11.2) compared to first and all (see above). Conclusion Women with SLE are at increased risk of early-onset preeclampsia and this increased risk may be independent of the traditional risk factors pregestational hypertension, APS, BMI, or smoking. Women with SLE during pregnancy should be closely monitored for early-onset preeclampsia and future research needs to identify the non-traditional preeclampsia factors that might cause this serious outcome.

Preterm birth phenotypes in women with autoimmune rheumatic diseases: a population‐based cohort study

“…18 Generally, women with SLE, SSc, and DM/PM had higher risks of PTB at earlier gestational ages, i.e.…”

“…Medically indicated early (20-31 weeks of gestation) PTB was particularly elevated for women with SLE, potentially owing to the high risk of severe pre-eclampsia. 18…”

Influence of disease activity and medications on offspring birth weight, pre-eclampsia and preterm birth in systemic lupus erythematosus: a population-based study

“…Pre-eclampsia is one of the risk factors for preterm birth. The increased risk of pre-eclampsia including early-onset pre-eclampsia (before 34 weeks) in SLE may be independent of traditional risk factors such as pregestational hypertension and body mass index (BMI) 2. High disease activity and flare shortly before or during pregnancy are factors predictive for complications,3–5 whereas no or low disease activity is favourable 6.…”

Risk of preeclampsia in patients with genetic predisposition to common medical conditions: a case-control study

“…Women with SLE are at increased risk of PE, particularly early-onset PE, even after adjustment for chronic hypertension and antiphospholipid antibody syndrome (APS) 47 . While lupus nephritis, APS, and chronic hypertension with SLE are associated with the highest risk of PE, even uncomplicated SLE in remission is associated with increased risk 48 .…”