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Risk of Preeclampsia in Lupus

Having Lupus puts A Pregnant Woman at Risk for Preeclampsia

Women who become pregnant are at risk for preeclampsia if they have systemic lupus erythematosus (SLE), also called lupus, according to researchers. If you become pregnant and develop high blood pressure, a woman is at risk for preeclampsia. This dangerous condition causes excessive protein in the urine of the pregnant woman after around 20 weeks of gestation. Preeclampsia is a life-threatening disorder for both the mother and the unborn child.

SLE is an autoimmune disease where the body's immune system produces antibodies to cells, and this leads to widespread tissue damage from inflammation. Experts are unsure of the exact cause of SLE, but people with this condition suffer joint pain and swelling, skin rashes, fatigue, and fevers. Females are affected more than males, and African Americans are affected more than whites. Prevalence varies, with the Lupus Foundation of American reporting that 1.5 million people in the U.S. are affected. However, the CDC reports that only around 350,000 people actually have this disease.

Pregnant Women with Autoimmune Diseases Studied

New research studies show that women with lupus have a two-fold increase risk of developing preeclampsia during pregnancy. According to the report published in Arthritis Care and Research, the use of Disease-Modifying Antirheumatic Drugs (called DMARDs) in the study population was rare. However, women who took these drugs had an increased preeclampsia risk, which could be explained by the lupus severity. DMARDs are used for people with SLE to prevent disorder flares.

Pregnant women with autoimmune diseases have always been at increased risk for preeclampsia, but DMARD use increases this risk. The researchers think that DMARDS diminish the maternal immune response to the placenta, and this plays a role in the preeclampsia onset. To explore their hypothesis, they studied women between 1997 and 2006.

Women with Lupus have Two-Fold Increased Risk for Preeclampsia

British Columbian researchers compared the risk of preeclampsia in DMARD users using a healthcare database that identified over 300,000 pregnant women. Of the study participants, women who had lupus and took DMARDs before were considered "past users," and those who took the medication during the first 20 weeks of pregnancy were called "continuous users." The results found that pregnant women of the study had a median age of 30 years. The scientists also noted that 1,226 women used DMARDs in the year prior to pregnancy while only 414 of the women used them during their pregnancies. After excluding women using antimalarial drugs, the relationship between DMARD use and preeclampsia remained.

The most commonly used DMARD was hydroxychloroquine, which was followed by chloroquine and azathioprine. Other medications taken by these women were corticosteroids (0.8%) and nonsteroidal anti-inflammatory drugs (NSAIDS) (2.1%). Many of the pregnant women were using these drugs for osteoarthritis and other conditions.

Conclusions

A continuous DMARD user was at greater risk for preeclampsia when compared to past DMARD users. The risk was more noted in women with SLE compared to those who did not have an autoimmune disorder. The lead researcher, Ms. Palmsten, reports that these findings uphold previous evidence, which show that women with lupus had two times the risk for preeclampsia development. This increased risk found in the DMARD users was reduced when the scientists accounted for the potential effect of the SLE. This suggests that the underlying autoimmune disease was a contributing factor to the increased risk of preeclampsia in the DMARD user group.

Resources:

http://www.medicalnewstoday.com/releases/252218.php

http://www.cdc.gov/arthritis/basics/lupus.htm

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