US researchers report that women with systemic lupus erythematosus (SLE) have a twofold higher risk for developing preeclampsia than women without an autoimmune disease.
They also found that women who used disease-modifying antirheumatic drugs (DMARDs) during pregnancy had an increased risk for preeclampsia, but this finding was nonsignificant.
Patients with autoimmune disease such as SLE and rheumatoid arthritis (RA) are typically treated with DMARDs to prevent disease flares.
"Understanding how DMARD use impacts women with autoimmune disease is important especially during pregnancy, as previous research found that women with SLE had at least a two-fold increase in preeclampsia risk and women with RA had a two-fold increase of this severe pregnancy complication," said study author Kristin Palmsten (Harvard School of Public Health, Boston, Massachusetts) in a press statement.
To investigate further, Palmsten and co-authors used the British Columbia healthcare utilization database to identify 306,831 pregnancies in 224,827 women. Those who filled a prescription for DMARDs, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids before pregnancy were classed as "past users" while those who filled these prescriptions before and during the first 20 weeks of pregnancy were classed as "continuous users."
Overall, use of DMARDs during pregnancy was rare (0.1%) in the study population.
The incidence of preeclampsia in past DMARD, corticosteroid, and NSAID users was 2.3%, 2.7%, and 2.9%, respectively. Compared with past DMARD users, continuous DMARD users were at a nonsignificant 2.29-fold increased risk for preeclampsia, writes the team in Arthritis Care and Research.
The DMARD and preeclampsia association was attenuated when women who used only antimalarials were excluded from the analysis and when the population was restricted to women with autoimmune disease. This, say Palmsten et al, suggests that the observed risk for preeclampsia in DMARD users was "likely due to underlying autoimmune disease."
Of note, preeclampsia risk was 2.02-fold greater in women with SLE compared with women without an autoimmune disease.
The researchers advise that "larger studies with detailed clinical data are needed to confirm our findings and should investigate the relationship between DMARD use and preeclampsia among women with specific autoimmune disease and should account for clinical measures of disease severity."
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