Female Veterans with Lupus or Rheumatoid Arthritis Have Higher Pregnancy Risks, Finds Study
USA: A study found that female veterans with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) had significantly higher rates of pregnancy loss and severe maternal morbidity compared to other veterans. These risks were elevated beyond those seen in the general population.
The investigation, published in ACR Open Rheumatology by Dr. Deirdre A. Quinn from the Center for Healthcare Evaluation, Research, and Promotion at the VA Pittsburgh Healthcare System and the University of Pittsburgh, assessed maternal outcomes among veterans with autoimmune conditions. Researchers emphasized that women with SLE and RA already face complex health challenges, and pregnancy further magnifies these risks.
The study involved a secondary analysis of national data from the US Department of Veterans Affairs (VA). The research team focused on veterans between 18 and 45 years old who had at least one pregnancy between October 2009 and September 2019, along with a VA primary care visit within the year before conception. Using diagnostic codes, the investigators identified cases of SLE and RA, along with related comorbidities. Severe maternal morbidity (SMM)—defined by the Centers for Disease Control and Prevention—was tracked during pregnancy and up to 42 days postpartum.
Key findings were as follows:
- Out of nearly 30,000 veterans analyzed, 113 were diagnosed with systemic lupus erythematosus (SLE) and 92 with rheumatoid arthritis (RA).
- Pregnancy loss was notably higher in these groups: 36% of women with SLE and 30.4% with RA had nonlive birth outcomes, including stillbirth, ectopic pregnancy, or spontaneous abortion.
- In comparison, only 25.2% of veterans without autoimmune diseases experienced similar outcomes.
- Severe maternal morbidity was also elevated, affecting nearly 10% of women with SLE and 4.3% of those with RA.
- By contrast, just 3.2% of the wider veteran population experienced such complications.
- The maternal health issues observed included life-threatening conditions such as cardiovascular events, severe infections, and hemorrhage, all of which pose risks to both survival and long-term health.
To the authors’ knowledge, this is the first study to evaluate severe maternal morbidity specifically among veterans with SLE or RA. The results highlight not only the disproportionate risk faced by these women but also the need for enhanced maternity care strategies tailored to veterans with systemic autoimmune rheumatic diseases.
The VA, the largest integrated health system in the United States, serves a medically and socially complex patient population. While the VA has developed coordinated maternity care models that integrate social and medical support, the study suggests more targeted approaches may be required for women with autoimmune conditions.
The authors noted that additional research is needed to explore how existing VA maternity programs can be adapted to mitigate these risks and improve pregnancy outcomes for veterans with SLE, RA, and potentially other systemic autoimmune diseases. By identifying these gaps, the study highlights the importance of specialized prenatal and postpartum care, as well as closer monitoring of high-risk pregnancies in this population.
"Veterans living with lupus or rheumatoid arthritis face elevated risks of both pregnancy loss and severe maternal morbidity. These findings reinforce the need for comprehensive, individualized maternity care models within the VA system to better support the reproductive health of women veterans," the authors concluded.
Reference:
Quinn, D. A., Sileanu, F. E., Procario, G. T., Mitchell, S., & Talabi, M. B. (2025). Severe Maternal Morbidity During and After Pregnancy Among Veterans With Systemic Lupus Erythematosus or Rheumatoid Arthritis. ACR Open Rheumatology, 7(9), e70100. https://doi.org/10.1002/acr2.70100
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