Although pregnancy in systemic lupus erythematosus (SLE) carries a high risk for mother and fetus, outcomes may be improving. In-hospital maternal mortality decreased from 1998 to 2015 in systemic lupus erythematosus (SLE) and non-SLE pregnancies, with a greater decline for SLE pregnancies, according to a study published online July 9 in the Annals of Internal Medicine.

Bella Mehta, M.B.B.S., from the Hospital for Special Surgery and Weill Cornell Medicine in New York City, and colleagues examined nationwide trends and disparities in maternal and fetal complications among pregnant women with SLE in a retrospective cohort study conduct in the United States from 1998 to 2015. To assess nationwide trends and disparities in maternal and fetal complications among pregnant women with SLE.

In-hospital maternal mortality

Outcome measures in-hospital maternal mortality, fetal mortality, preeclampsia or eclampsia, caesarean sections, non–delivery-related admissions, and length of stay. To assess whether trends in outcomes over time differ between patients with SLE and those without SLE, logistic or linear regression with an interaction term between year and SLE (yes or no) use. Nationwide population estimates incorporating sampling and poststratification weights obtain.

The study was retrospective cohort in nature. An estimate 93 820 pregnant women with SLE and 78 045 054 without SLE were hospitalize in the United States from 1998 through 2015. Outcomes improve during those 18 years. In-hospital maternal deaths (per 100 000 admissions) declined among patients with as well as those without SLE (442 vs. 13 for 1998 to 2000 and <50 vs. 10 for 2013 to 2015), although the decrease was greater in women with SLE (difference in trends, P < 0.002).

Pregnancy-related and delivery-related admissions

The percentage of patients with SLE in all pregnancy-related, as well as delivery-related, admissions increased significantly. During those 18 years, outcomes improved. Among patients with and those without SLE, there was a decrease in in-hospital maternal deaths (per 100,000 admissions; 442 versus 13 for 1998 to 2000 and <50 versus 10 for 2013 to 2015); a greater decrease was for women with SLE.

In all pregnancy-related and delivery-related admissions, the percentage of patients with SLE increase significantly. The sample for this analysis was identify by using diagnostic codes; detailed information on hospital-specific trends, SLE disease activity, and medications was not available. Race trends could not be analyze. Given that NIS uses weighted estimates, the incidence of outcomes reported may not be exact.

“Our study provides nationwide evidence that SLE pregnancy outcomes have become markedly better in the past two decades and continue to improve,” the authors write. “However, SLE pregnancy risks remain high, and more work is needed to ensure good pregnancy outcomes among women with SLE.”