3 AC&R Study Summaries: Maternal Health & SLE, Pregnancy Outcomes & Coordinated Ophthalmic & Rheumatologic Care

Maternal Health Insights in Patients with SLE

The impact of pregnancy readiness on lupus activity, maternal mental health & pregnancy outcomes

By Ceshae Harding, MD, & Megan Clowse, MD, MPH

Why was this study done? Patients with systemic lupus erythematosus (SLE) who are pregnant have increased risks of risks maternal and fetal mortality, preeclampsia and cesarean sections than do members of the general population. Helping women with SLE time their pregnancy to coincide with minimal lupus activity, use of pregnancy-compatible medications and when they desire conception may improve health and well-being for both the mother and infant. In this study among individuals with SLE who became pregnant, we explored the impact of medical readiness for pregnancy and personal readiness for pregnancy on the following: provider-reported disease activity, patient-perceived disease activity, mood symptoms, pregnancy-related health behaviors and pregnancy outcomes.

What were the study methods? All study participants were enrolled in a prospective registry, met Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE and had at least one pregnancy. Being medically ready for pregnancy was defined as: <1 g of proteinuria, no rheumatic teratogens at conception and continuing pregnancy-compatible SLE medications after conception. Being personally ready for pregnancy was defined as a planned pregnancy based on a London Measure of Unplanned Pregnancy ≥10. Multivariable logistic regression models estimated the association of pregnancy readiness with each outcome of interest.

What were the key findings? In patients with SLE, not being medically ready for pregnancy was associated with significantly higher provider-reported disease activity; however, these patients did not perceive themselves as having higher disease activity. Not being personally ready for pregnancy was associated with significantly higher patient-perceived disease activity and higher maternal symptoms of depression. Being both medically and personally ready for pregnancy was associated with lower rates of preeclampsia and improved gestational length.

What were the main conclusions? For maternal mental health and quality of life among individuals with SLE, greater focus is needed on decreasing the incidence of unplanned pregnancy. To improve pregnancy outcomes, greater focus is needed on improving medical optimization prior to conception in this higher risk population.

What are the implications for patients & clinicians? Reproductive-aged individuals with chronic disease are a unique population in whom disease management should always account for reproductive potential and personal goals.

This study speaks to the critical need for provider-initiated discussions around pregnancy planning, which allows individuals with SLE to make informed decisions with regard to family planning. To improve maternal health in patients with SLE, we must work toward increasing the proportion of pregnancies that are planned and medically optimized.