March 23, 2020
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Abortion does not worsen rheumatic disease outcomes

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Michael D. Lockshin

Neither elective nor medically indicated abortions resulted in worse outcomes among patients with autoimmune rheumatic diseases, according to data published in Arthritis & Rheumatology.

“Patients and doctors often ask about comparative safety of continuing or ending pregnancy, but there is almost no published information on this topic,” Michael D. Lockshin, MD, of the Barbara Volcker Center for Women and Rheumatic Disease and Hospital for Special Surgery, in New York, told Healio Rheumatology. “Because of the absence of published data, the recently published American of College of Rheumatology reproductive health guidelines were unable to address this topic, and were criticized for not doing so.”

He added, “For ethical, personal, legal and health care reasons, there will never be a controlled trial on termination of pregnancy, so a presentation of observational data like ours provides at least some background to inform physicians and patients.”

To provide reference data on the frequency and safety of elective abortion among patients with autoimmune rheumatic diseases, Lockshin and colleagues analyzed patients from the Barbara Volcker Center (BVC) for Women and Rheumatic Disease, which focuses on pregnancy and autoimmune disease at the Hospital for Special Surgery. Researchers also examined data from the “Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus” (PROMISSE) study.

Neither elective nor medically indicated abortions resulted in worse outcomes among patients with autoimmune rheumatic diseases
Neither elective nor medically indicated abortions resulted in worse outcomes among patients with autoimmune rheumatic diseases, according to data.

The BVC database is a complete electronic medical record of charted outpatient visits between May 2002 and January 2016, and all laboratory information from January 2007 through January 2016. In the multicenter, prospective observational PROMISSE study, investigators examined 445 patients with SLE, antiphospholipid antibody/antiphospholipid syndrome or both conditions, as well as singleton pregnancies of 12 or fewer weeks’ duration. They also recorded historical elective abortion frequency for patients with prior pregnancies.

Researchers wrote that among women with prior pregnancies, 21.7% of the 1,307 patients in the BVC database and 25.3% of the 297 participants in the PROMISSE study had histories of one to five previous elective abortions. Patients in the BVC database reported no flare or hospitalizations due to complications related to the procedure. Among the 674 incident pregnancies, termination for fetal or maternal reasons was recommended in 2% of cases. Of these cases, two fetuses died before the procedure was carried out and one individual declined termination, and, although gravely ill, successfully delivered. This individual died of cardiomyopathy 3 years later, the researchers wrote.

“There are no adverse signals — there is no evidence that termination of pregnancy, whether elective or medically indicated, worsens the status of patients with systematic autoimmune diseases,” Lockshin said. “When patients’ lives are threatened, termination may improve their status.” – by Jason Laday

Disclosures: Lockshin reports no relevant financial disclosures. Co-author Jane E. Salmon, MD, of the Hospital for Special Surgery and Weill Cornell Medicine, in New York, reports a grant from UCB.