Lupus: maternal deaths dramatically decline over 2 decades

  • Ann Intern Med

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • A large US cohort study finds that in-hospital maternal deaths over the course of the last 18 years in patients with systemic lupus erythematosus (SLE) has declined from 34 times higher than non-SLE pregnancies to less than 5 times higher.

Why this matters

  • The authors still regard SLE as a high-risk pregnancy.
  • An editorial regards the progress as "substantial," but still perceives the need for further progress and is concerned about preeclampsia and fetal deaths.

Study design

  • Retrospective cohort using the National Inpatient Sample, which covers 99% of the US hospitalized population from 1998 to 2000 and 2013 to 2015.
  • Outcomes were analyzed for pregnant women with SLE (n=93,820) compared with those without SLE (n=78,045,054).
  • Funding: None.

Key results

  • Maternal deaths among SLE (vs non-SLE) pregnancies declined from 442 vs 13 to
  • Fetal deaths among SLE (vs non-SLE) pregnancies nonsignificantly declined from 268 vs 72 to 153 vs 66 per 10,000 deliveries; difference in trends, P=.064.
  • Preeclampsia or eclampsia among SLE (vs non-SLE) pregnancies declined from 9.5% vs 3.3% to 9.1% vs 4.1% of deliveries; difference in trends, P<.001.>

Limitations

  • Retrospective, observational design.
  • No data on hospital-specific trends, SLE disease activity, and medications.