In pregnant women with SLE , spontaneous and indicated preterm birth proportions are high, Meta-analysis finds

Recent meta-analysis conducted by Abheiden et al. aimed to determine the proportions of spontaneous and indicated preterm birth in pregnancies of women with systemic lupus erythematosus (SLE). The study included 21 articles with data from 8157 pregnancies and found that, on average, 31% of the pregnancies resulted in preterm birth, including 14% spontaneous and 16% indicated preterm birth. It was noted that pregnancies were almost equally affected by spontaneous and indicated preterm birth, which is a noteworthy finding as the risk of spontaneous preterm birth is less well recognized in women with SLE. The study highlighted the implications of these findings for counseling and management in pregnancy. The authors emphasized the importance of applying this information in (prepregnancy) counseling and management in pregnancy. They also highlighted the need to increase awareness among treating physicians and to provide better instructions to patients during pregnancy. The high proportions of spontaneous and indicated preterm birth in women with SLE were considered important for guiding further research on associated risk factors and the development of interventions to reduce spontaneous preterm birth in SLE pregnancies.

Risk Factors and Causes

The study discussed possible risk factors for spontaneous preterm birth in women with SLE, including inflammation due to systemic disease, increased production of cytokines and prostaglandins, placental insufficiency, and other factors such as viral or bacterial infections and fibroid necrosis. It was also pointed out that the high proportion of preterm prelabor rupture of membranes (PPROM) instances in this study should be further investigated to determine the cause and whether the risk can be reduced.

Potential Interventions

The meta-analysis also discussed potential interventions to reduce spontaneous preterm birth in women with SLE, including routine universal midtrimester sonographic cervical length evaluation, the use of vaginal progesterone, and the prescription of aspirin to prevent hypertensive disorders of pregnancy. However, the authors noted a lack of studies in the specific population of women with SLE, and called for further research to evaluate the potential beneficial effects of these interventions.

Acknowledged Limitations

The study acknowledged certain limitations, such as heterogeneities in the available studies, possible publication bias, and the lack of detailed information concerning women with SLE experiencing preterm birth. Despite these limitations, the findings of the meta-analysis provide important insights into the high proportions of spontaneous and indicated preterm birth in women with SLE and the implications for counseling, management, and further research.

Key Points

1. The meta-analysis aimed to determine the proportions of spontaneous and indicated preterm birth in pregnancies of women with systemic lupus erythematosus (SLE) and included 21 articles with data from 8157 pregnancies. It found that, on average, 31% of the pregnancies resulted in preterm birth, including 14% spontaneous and 16% indicated preterm births. This suggests that pregnancies of women with SLE are almost equally affected by spontaneous and indicated preterm birth.

2. The study highlighted the implications of these findings for counseling and management in pregnancy. The authors emphasized the importance of applying this information in (prepregnancy) counseling and management in pregnancy. They also highlighted the need to increase awareness among treating physicians and to provide better instructions to patients during pregnancy.

3. The high proportions of spontaneous and indicated preterm birth in women with SLE were considered important for guiding further research on associated risk factors and the development of interventions to reduce spontaneous preterm birth in SLE pregnancies.

4. The study discussed possible risk factors for spontaneous preterm birth in women with SLE, including inflammation due to systemic disease, increased production of cytokines and prostaglandins, placental insufficiency, viral or bacterial infections, and fibroid necrosis. Furthermore, the study pointed out the need for further investigation into the high proportion of preterm prelabor rupture of membranes (PPROM) instances in this population.

5. Potential interventions to reduce spontaneous preterm birth in women with SLE were also discussed, including routine universal midtrimester sonographic cervical length evaluation, the use of vaginal progesterone, and the prescription of aspirin to prevent hypertensive disorders of pregnancy. However, the authors noted a lack of studies in the specific population of women with SLE and called for further research to evaluate the potential beneficial effects of these interventions.

6. The study acknowledged certain limitations, such as heterogeneities in the available studies, possible publication bias, and the lack of detailed information concerning women with SLE experiencing preterm birth. Despite these limitations, the findings of the meta-analysis provide important insights into the high proportions of spontaneous and indicated preterm birth in women with SLE and the implications for counseling, management, and further research.

Reference -

Abheiden CNH, Blomjous BS, Slaager C, Landman AJEMC, Ket JCF, Salmon JE, Buyon JP, Heymans MW, de Vries JIP, Bultink IEM, de Boer MA. Systemic lupus erythematosus is associated with an increased frequency of spontaneous preterm births: systematic review and meta-analysis. Am J Obstet Gynecol. 2024 Oct;231(4):408-416.e21. doi: 10.1016/j.ajog.2024.03.010. Epub 2024 Mar 16. PMID: 38492714.