title: Pregnancy outcomes and contraceptive use in patients with systemic lupus Erythematosus, rheumatoid arthritis and women without a chronic illness: a comparative study.
abstract: OBJECTIVE
  To compare the pregnancy outcomes and contraceptive practices in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and women with no chronic illness (WNCI) in a tertiary care referral center in Colombo, Sri Lanka.
  
  
  METHODS
  Patients with SLE satisfying American College of Rheumatology criteria for diagnosis and history of pregnancies were recruited from university lupus clinic, National Hospital of Sri Lanka (NHSL). Age-matched women with history of pregnancy and RA were recruited from the rheumatology clinic, NHSL and WNCI from a surgical clinic.
  
  
  RESULTS
  In 71 patients with SLE, 79 pregnancies occurred in 38 patients. The number of total pregnancies in SLE, RA and WNCI (79, 80 and 85 respectively) were not significantly different (P > 0.05), but most occurred before diagnosis of SLE and RA. Pregnancies occurring after diagnosis were significantly higher in SLE compared to RA (P = 0.013, χ2= 6.169). Mean age at diagnosis was higher (P < 0.01) in RA (35 years) than in SLE (26 years). Percentage live births 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 fetal outcomes (fetal loss, pre-maturity, low birth weight) and assisted deliveries were significantly more (P < 0.001) in SLE than in WNCI. Unplanned pregnancies were significantly higher (P < 0.01) in SLE (80%) compared to RA (25%) and in WNCI (9.4%). Contraceptive usage was lower in patients with SLE (25.6%) and RA (33%) compared to WNCI (56.4%). Disease exacerbations occurred in 20% of SLE patients during pregnancy.
  
  
  CONCLUSIONS
  More pregnancies occur in SLE than in RA after diagnosis of illness. Unplanned pregnancies and adverse pregnancy outcomes need to be addressed more in SLE than in RA or in WNCI.
authors.affiliation: Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.|University Lupus Clinic, National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Priyadarshani
authors.initials: P
authors.lastname: Galappatthy
authors.affiliation: Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Jayan D D
authors.initials: JDD
authors.lastname: Jayasinghe
authors.affiliation: Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Sampath C
authors.initials: SC
authors.lastname: Paththinige
authors.affiliation: University Lupus Clinic, National Hospital of Sri Lanka, Colombo, Sri Lanka.|Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Rezvi M H
authors.initials: RMH
authors.lastname: Sheriff
authors.affiliation: National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Lalith S
authors.initials: LS
authors.lastname: Wijayaratne
mesh_terms: D000293:Adolescent; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D016009:Chi-Square Distribution; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D050498:Live Birth; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D011256:Pregnancy Outcome; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D012307:Risk Factors; D013188:Sri Lanka; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female
keywords: contraceptive use; fetal loss; planned pregnancy; pregnancy outcome; rheumatoid arthritis; systemic lupus erythematosus