Women with lupus, an autoimmune disorder that can attack a variety of tissues, were once counseled to avoid pregnancy. Now, physicians tailor their advice to each patient's case. In many instances, however, it's difficult for physicians to gauge what types of risk their patient might be facing.
A new study designed to clarify those risks found that women with lupus during pregnancy — and even women who may soon be diagnosed with lupus — are more likely to experience preeclampsia, stroke and infection than women without lupus. Infants born to mothers with lupus or pre-lupus are also more likely to be born preterm, have infections, or be small for gestational age, according to the paper, which was published today in Arthritis Care and Research.
"We’ve confirmed previous findings while strengthening the data to show that lupus is associated with a variety of adverse pregnancy outcomes both to the mother, and to the infant," said senior author Julia Simard, ScD, assistant professor of health research and policy at Stanford.
The research team, which included collaborators in Sweden and at several U.S. universities, examined data from population-based Swedish registers. That data set allowed the researchers to identify patients who had babies several years before being diagnosed with lupus. From 13,598 single, first-time births, the team identified 551 women with existing lupus and 198 who presented with lupus within five years after giving birth.
For women who have not yet been diagnosed, it's possible that autoantibodies implicated in the disease may lead to some of the adverse outcomes, but the exact mechanisms remain unknown, Simard said.
She and others are also working to clarify the clinical ramifications of the work, which may help refine physicians' recommendations and care of pregnant women with lupus, and may lead to earlier diagnoses.
This is a descriptive study, Simard cautioned. Lupus is a challenging condition to study, because it can manifest differently in every patient. As with other chronic diseases, it's also difficult to distinguish between conditions that could strike anyone, and conditions that might be caused by lupus, she said.
Previously: Empowered is as empowered does: Making a choice about living with lupus, Women and men's immune system genes operate differently, Stanford study shows , Lupus and rheumatoid arthritis may mean fewer children for female patients and Why some autoimmune diseases go into remission during pregnancy
Photo by J.K. Califf