Pregnant Women with Systemic Lupus Erythematosus may have high Risk of Preterm Birth: Study

Systemic lupus erythematosus is an autoimmune disease that clinically can be associated with much complexity in the pregnancy. Preterm birth has been known for a long time as a complication often due to hypertensive disorders or fetal growth restriction that prompts medical intervention; however, rates of spontaneous preterm birth, those occurring without medical intervention, are still understudied in women with SLE.

A systematic electronic search was carried out on databases including PubMed, Embase, Web of Science, and Google Scholar. The search conducted in June 2021 was limited to original articles published between 1995 and June 2021. For inclusion, studies had to report the rates of spontaneous and indicated preterm births among pregnant women with SLE.

The studies included were assessed using the Newcastle–Ottawa quality assessment scale. A random-effects model-based meta-analysis of single proportions was performed to estimate pooled event rates and the corresponding 95% CI for preterm births in pregnancies complicated by SLE, estimating both spontaneous and indicated preterm births more precisely.

A total of 21 studies summarizing data from 8,157 pregnancies in women with SLE were included in the meta-analysis. Meta-analysis indicated that preterm birth was a most common complication of pregnancy; 31% of all the pregnancies were affected.

Of these:

• 14% were spontaneous preterm births, meaning they are when no medical intervention is performed, and a baby born before 37 weeks of gestation occurred; prediction interval at 95%, 0.04–0.27).

• 16% were indicated preterm births where they originate due to complications secondary to hypertension disorders or fetal growth restriction, or other specific medical conditions; prediction interval at 95%, 0.03–0.35).

Pregnant women with systemic lupus erythematosus are at a significant risk for preterm birth with pregnancies ending before 37 weeks of gestation. The prevalence of spontaneous and indicated preterm births accounts for a proportion of the risks documented. Thus, these observations urge comprehensive prenatal counseling and management practices for women with SLE, strategies to prevent both spontaneous and indicated preterm births. Additional research is needed to identify predictive factors and design interventions for decreasing the incidence of preterm birth in women with SLE, thus further improving pregnancy outcomes in SLE.

Reference:

Abheiden, C. N. H., Blomjous, B. S., Slaager, C., Landman, A. J. E. M. C., Ket, J. C. F., Salmon, J. E., Buyon, J. P., Heymans, M. W., de Vries, J. I. P., Bultink, I. E. M., & de Boer, M. A. (2024). Systemic lupus erythematosus is associated with an increased frequency of spontaneous preterm births: systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 231(4), 408-416.e21. https://doi.org/10.1016/j.ajog.2024.03.010