African American women with lupus at higher risk for adverse perinatal outcomes
African American women with systemic lupus erythematosus were found to be at increased risk for preterm and small-for-gestational age births, even prior to clinical diagnosis, according to data published in Arthritis Care & Research.
“Despite the interest in pregnancy outcomes among women with SLE, important gaps in the literature remain,” Meghan Angley, PhD, MPH, of the department of epidemiology in the Rollins School of Public Health at Emory University, and colleagues wrote. “There is limited research on preterm birth and [small-for-gestational age] (SGA) specifically among African American women with SLE, and only one study has examined perinatal outcomes before SLE diagnosis among African American women.”
They added: “In the present analysis, we examine the risk of preterm and small-for-gestational age birth among African American women with SLE compared to the general population of African American women in a large metropolitan area.”
Angley and colleagues analyzed 586 births to African American women with SLE identified from the Georgia Lupus Registry and the Georgians Organized Against Lupus Cohort. Participants were linked with birth certificates by the Georgia Department of Public Health, and comparison births certificates to African American women in the same geographic region were obtained from the National Center for Health Statistics.
Births were designated into four categories: occurring more than 3 years before SLE diagnosis, 0 to 3 years before SLE diagnosis, 0 to 3 years after SLE diagnosis or more than 3 years after SLE diagnosis. Log-risk models were used to compare the risk of preterm birth or SGA among SLE births in each diagnosis timing category to the general population, adjusting for maternal age, education and parity.
“Overall, 28.5% of births in our cohort of African American women with SLE were preterm, compared to 15.5% among African American women in the general population,” Angley and colleagues wrote.
Researchers found that births to women with SLE were most likely to occur preterm 3 or more years after diagnosis (RR = 2.83, 95% CI: 2.36, 3.38), followed by 0 to 3 years after SLE diagnosis (RR = 2.29, 95% CI: 1.70, 3.09) and 0 to 3 years before SLE diagnosis (RR = 1.71; 95% CI 1.24-2.35). However, this was not observed in the 3 or more years before SLE diagnosis group compared with the general population (RR = 1.03; 95% CI, 0.77-1.38).
Though similar results were recorded for SGA, the researchers noted the pattern was different.
“The risk of SGA birth was 10.9% more than 3 years before diagnosis, but 27.9% within 3 years after diagnosis,” the researchers added. “By more than 3 years after SLE diagnosis, the proportion of births that were SGA was 21.3% of births. More work remains to be done to characterize the additional risks around pregnancy and childbirth that African American women with SLE face. Healthcare providers, especially those in communities of color, should be better educated about SLE and have a lower threshold to suspect SLE in the peripartum period.”