Study reports increased spontaneous preterm birth risk from systemic lupus erythematosus

Study reports increased spontaneous preterm birth risk from systemic lupus erythematosus | Image Credit: © ondrooo - © ondrooo - stock.adobe.com.

The risks of spontaneous and indicated preterm birth (PTB) are significantly increased in pregnant women with systemic lupus erythematosus (SLE), according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Outcomes associated with SLE in pregnancy include hypertensive disorders of pregnancy, fetal growth restriction, fetal loss, and PTB. Of these outcomes, PTB is one of the most common, impacting 30% to 40% of SLE pregnancies vs 10% of the general population.

PTB rates are increasing in the United States, with a rate of 10.5% in 2021 reported in the 2022 March of Dimes report card.² The rate was 4% higher than during the previous year, giving the United States a preterm birth grade of D+.

Data also indicated significant impacts among Black women, with a 52% higher birth rate than their White counterparts. This has led to a worsened disparity ratio of 1.26. Overall, authors found an urgent need to improve maternal and infant health outcomes in the United States.

While women with SLE pregnancies are warned about the risk of PTB, they are not often informed about the risk of spontaneous PTB.¹ Knowledge about the rates of spontaneous PTB vs indicated PTB in women with SLE is vital for increasing awareness and improving pregnancy counseling.

To determine spontaneous and indicated PTB rates in pregnant women with SLE, investigators conducted a systematic review and meta-analysis. Articles were identified through a systematic search of the Embase, PubMed, Google Scholar, and Web of Science databases.

Articles reporting on PTB and PTB type in women with SLE were included in the final analysis. Investigators defined spontaneous PTB as, “spontaneous contractions leading to PTB or preterm prelabor rupture of membranes (PPROM) leading to PTB.” Exclusion criteria included being a lower quality duplicate and being published before 1995.

Independent screening was performed by at least 2 reviewers, beginning with title and abstract screening and followed by screening in EndNote (Clarivate, London, United Kingdom). Data extraction was performed using a standardized form.

Relevant data included cohort type, how SLE was diagnosed, baseline data, disease characteristics, maternal and fetal outcomes, and data analysis. The Newcastle - Ottawa quality assessment Scale was used to assess the quality and risk of bias.

There were 21 articles published between 1995 and 2020 included in the final analysis. Of these, 11 were retrospective cohort studies, 7 were prospective cohort studies, 1 was a population-based data set, 1 was an observational cohort study, and 1 used maternally linked hospital and birth certificate records.

The studies included 8157 total pregnancies. Good quality was reported in 15 of the articles, fair quality in 1, and poor quality and 5. Of SLE pregnancies evaluated, 31% had PTB, with 46% of these cases being spontaneous PTB while 53% were indicated PTB. These rates were 14% and 16%, respectively, in all ongoing pregnancies.

Fifty-one percent of spontaneous PTB cases began with PPROM, and 73% of women with PPROM in one study used prednisone during pregnancy. Prednisone use was also reported in 48% of pregnant women in the whole study population with SLE.

These results indicated high rates of spontaneous and indicated PTB among pregnant women with SLE. Investigators recommended additional research about interventions that can improve pregnancy outcomes in women with SLE.

References

1. Abheiden CNH, Blomjous BS, Slaager C, et al. Systemic lupus erythematosus is associated with an increased frequency of spontaneous preterm births: systematic review and meta-analysis. American Journal of Obstetrics & Gynecology. 2024;231(4):408-416.E21. doi:10.1016/j.ajog.2024.03.010
2. Krewson C. Preterm births increasing in United States. Contemporary OB/GYN. December 6, 2022. Accessed September 25, 2024. https://www.contemporaryobgyn.net/view/preterm-births-increasing-in-united-states