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Mothers with lupus have smaller infants, more stillbirths: trend toward improvement.

NEW ORLEANS -- Women with systemic lupus erythematosus are more likely than other women to experience a stillbirth and to give birth before term, despite recent advances in lupus treatment, Dr. Robert Sokol reported in a series of posters presented at the annual meeting of the Society for Maternal-Fetal Medicine.

But the 17-year study of pregnancy outcomes in women with systemic lupus erythematosus (SLE) did show two encouraging trends: a slight decrease in the stillbirth rate of these infants; and an indication that, although they are still more likely to be born early, the infants are growing better in utero.

"Although these trends weren't statistically significant, they were still apparent," said Dr. Sokol of Wayne State University, Detroit. "We think this reflects improvements in technology, medical care, and treatment of lupus. We're intervening earlier and more aggressively and getting better outcomes."

Dr. Sokol presented the results of Dr. Patricia Dahr's cohort analysis of 327 women with SLE. Dr. Dahr, also of Wayne State, compared the first pregnancy of each patient in the SLE group to the first pregnancy of each patient in a control group of 78,905 women without the disease.

Women with SLE were four times more likely than controls to experience a stillbirth. Overall, the rate of stillbirth in the SLE group was 55/1,000 pregnancies, compared with a rate of 13/1,000 in the control group.

However, stillbirths among the SLE group did decline over the study period, falling from an overall rate of 7/1,000 pregnancies in 1985 to about 3/1,000 pregnancies in 2002.

Given the large sample size and the limitation that only first pregnancies were studied, Dr. Dahr said in her poster that the analysis should represent one of the most reliable estimates of the stillbirth rate among SLE patients.

When the groups were analyzed for low birth weight and gestational age, the infants of SLE patients were born earlier, at a mean of 36 weeks.

Although these infants weighed consistently less at birth (a mean of 2,790 g) than did infants in the control group, their mean birth weights showed a trend of improvement over the length of the study, rising from the fifth percentile in 1985 to the sixth percentile in 2002.

"We speculate that this might reflect advancing technology of care and improved intervention, most notably, aggressive thrombophilia assessments and treatment as well as concurrent thermatology care during pregnancy," Dr. Sokol told this newspaper.

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Title Annotation:Women's Health
Author:Sullivan, Michele G.
Publication:Family Practice News
Geographic Code:1USA
Date:Jul 15, 2004
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