Effect of pregnancy on disease flares in patients with systemic lupus erythematosus

Amanda M. Eudy, Anna Maria Siega-Riz, Stephanie M. Engel, Nora Franceschini, Annie Green Howard, Megan E.B. Clowse, Michelle Petri

Research output: Contribution to journalArticle

Abstract

Objective: Prior studies found conflicting results about whether lupus is likely to flare during or after pregnancy. Using a large cohort of pregnant and non-pregnant women with lupus, we estimated the effect of pregnancy on disease flares in systemic lupus erythematosus. Methods: Data were collected in the Hopkins Lupus Cohort 1987-2015. Women aged 14-45 years with >1 measurement of disease activity were included. The time-varying exposures were classified as pregnancy, postpartum or non-pregnant/non-postpartum periods. Flares were defined as: (1) change in Physician Global Assessment (PGA)≥1 from previous visit and (2) change in Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI)≥4 from previous visit. A stratified Cox model estimated HRs with bootstrap 95% CIs. Results: There were 1349 patients, including 398 pregnancies in 304 patients. There was an increased rate of flare defined by PGA during pregnancy (HR: 1.59; 95% CI 1.27 to 1.96); however, this effect was modified by hydroxychloroquine (HCQ) use, with the HR of flares in pregnancy compared with non-pregnant/non-postpartum periods estimated to be 1.83 (95% CI 1.34 to 2.45) for patients with no HCQ use and 1.26 (95% CI 0.88 to 1.69) for patients with HCQ use. The risk of flare was similarly elevated among non-HCQ users in the 3 months postpartum, but not for women taking HCQ after delivery. Conclusions: Our study supports and extends previous findings that the incidence of flare is increased during pregnancy and within the 3 months postpartum. Continuing HCQ, however, appeared to mitigate the risk of flare during and after pregnancy.

Original languageEnglish (US)
Pages (from-to)855-860
Number of pages6
JournalAnnals of the rheumatic diseases
Volume77
Issue number6
DOIs
StatePublished - Jun 1 2018

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Keywords

  • disease activity
  • epidemiology
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Eudy, A. M., Siega-Riz, A. M., Engel, S. M., Franceschini, N., Howard, A. G., Clowse, M. E. B., & Petri, M. (2018). Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Annals of the rheumatic diseases, 77(6), 855-860. https://doi.org/10.1136/annrheumdis-2017-212535