(402) Trends in and outcomes associated with systemic lupus erythematosus and anti-phospholipid syndrome during U.S. deliveries

Objective: Systemic Lupus Erythematosus (SLE) in pregnancy has been associated with increased rates of adverse obstetric outcomes, but updated population level data is lacking. Also, the effect of anti-phospholipid syndrome (APLS) on obstetric outcomes has not been characterized on a population level in the U.S. Our objective was to assess trends in obstetric complications associated with SLE and differences in outcomes based on APS status during delivery hospitalizations from 2000-2019.

Study Design: This repeated cross-sectional study analyzed delivery hospitalizations among women aged 15-54 years using the National Inpatient Sample. Temporal trends in SLE were analyzed using jointpoint regression to estimate the average annual percent change (AAPC) with 95% confidence intervals (CIs). Survey adjusted logistic regression models were fit to examine the association between SLE and/or APS and cesarean deliveries, preterm deliveries, stillbirths, eclampsia, ntSMM, maternal mortality, thrombosis, and hemorrhagic complications.

Results: From 2000 to 2019, the rate of maternal SLE increased from 6.65 to 14.61 cases per 10,000 delivery hospitalizations (AAPC 4.5%, 95% CI: 4.0, 5.1%). Clinical factors associated with SLE included obesity, pregestational diabetes, and chronic hypertension. In adjusted analyses accounting for age, other clinical factors and demographics, SLE was associated with increased odds of cesarean deliveries, preterm deliveries, stillbirths, eclampsia, ntSMM, mortality, thrombosis and hemorrhagic complications(Table 1). A diagnosis of APS increased the odds of having chronic hypertension or chronic kidney disease over two-fold, stillbirths over two-fold, eclampsia over five-fold, and of ntSMM five-fold compared to women with only SLE(Table 2).

Conclusion: SLE diagnoses have increased in obstetric populations and are associated with an increased risk of adverse outcomes at delivery hospitalizations. A diagnosis of APS further amplifies risks of adverse outcomes and co-morbidities. These findings support close, multi-disciplinary prenatal care of women with SLE and APS.