A comparative study on pregnancy outcomes and contraceptive use in patients with systemic lupus erythematosus and those with rheumatoid arthritis or no chronic illness

Abstract

Systemic Lupus Erythematosus (SLE) influences pregnancy outcomes. Objectives: To compare the pregnancy out comes and contraceptive practices in SLE with rheumatoid arthritis (RA) and women with no chronic illness (WNCI). Methods: Patients with SLE and history of pregnancies were identified from University lupus clinic. Age matched women with history of pregnancy and RA were obtained from rheumatology clinic and WNCI from a surgical clinic. Comparisons between live birth rates (LBR), pregnancy losses, contraceptive use and planned pregnancies in the three groups were done using chi square test. Results: In 78 patients with SLE, 59 pregnancies occurred before and 20 after diagnosis. In 32 patients with RA, 72 pregnancies occurred before and 8 occurred after diagnosis. The mean age at diagnosis was higher (p< 0.01) in RA (35years) than in SLE (26 years) using student t test. LBR after diagnosis was significantly lower (p<0.01) in SLE (9/20, 45%) compared to RA (6/8, 75%) and WNCI (77/85,91%). Adverse pregnancy outcomes (fetal loss, pre-maturity, low birth weight) and assisted deliveries Were more (p<0.001)in SLE than in WNCI. Unplanned pregnancies were more (p<0.01)in SLE (80%) Than in RA (25%) and in WNCI (9.4%). Contraceptive usage was lower in patients with SLE (25.6%) compared to WNCI (56.4%). Disease exacerbations occurred in 20% in SLE during pregnancy and no babies developed neonatal lupus. Conclusions:Unplanned pregnancies and adverse pregnancy outcomes need to be addressed more in SLE than in RA or in WNCI.