Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis.
OBJECTIVE
To estimate the national occurrence of pregnancies in women with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and to compare pregnancy outcomes in these patients with those in women with pregestational diabetes mellitus (DM) and with the general obstetric population.


METHODS
We studied the 2002 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project to estimate the number of obstetric hospitalizations, deliveries, and cesarean deliveries in women with SLE, RA, pregestational DM, and the general obstetric population. Pregnancy outcomes included length of hospital stay, hypertensive disorders including preeclampsia, premature rupture of membranes, and intrauterine growth restriction.


RESULTS
Of an estimated 4.04 million deliveries, 3,264 occurred in women with SLE, 1,425 in women with RA, and 13,574 in women with pregestational DM. Women with SLE, RA, and pregestational DM had significantly increased rates of hypertensive disorders compared with the general obstetric population (23.2%, 11.1%, 27.4%, and 7.8%, respectively), longer hospital stays, and significantly higher risk of cesarean delivery. Although women with SLE, RA, and pregestational DM were significantly older than women in the general obstetric population, disparities in the risk of adverse outcomes of pregnancy remained statistically significant after adjustment for maternal age.


CONCLUSIONS
To our knowledge, this is the first study to examine national data on pregnancy outcomes in women with common rheumatic diseases. As with underlying pregestational DM, women with SLE and RA appear to have a higher age-adjusted risk of adverse outcomes of pregnancy and longer hospital stays than do pregnant women in the general population, and careful antenatal monitoring should be performed.
Chakravarty
Eliza F
EF
Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA. echakravarty@stanford.edu
Nelson
Lorene
L
Krishnan
Eswar
E
D001172:Arthritis, Rheumatoid; D002585:Cesarean Section; D016640:Diabetes, Gestational / Q000628:therapy; D005260:Female; D005317:Fetal Growth Retardation / Q000628:therapy; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000628:therapy; D007902:Length of Stay; D008180:Lupus Erythematosus, Systemic; D011225:Pre-Eclampsia / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D014481:United States