Preeclampsia associated with rheumatic disease

[Guest guest]

Preeclampsia associated with rheumatic disease

Rheumawire

June 29, 2004

Nainggolan

Boston, MA - Pregnant women with rheumatological disease are more likely

to develop preeclampsia and have other adverse obstetric outcomes than

those without rheumatological disease, a new study shows.

Reporting their findings in the June 2004 issue of Obstetrics &

Gynecology [1], Dr Adam J Wolfberg (Brigham and Women's Hospital,

Boston, MA) and colleagues found an almost 4-fold increase in the

incidence of preeclampsia in women with autoimmune disease. In addition,

these women had an approximately 2-fold greater risk of certain adverse

pregnancy outcomes, including preterm delivery and

small-for-gestational-age (SGA) babies.

There was no increased risk, however, of intrauterine fetal demise or

congenital anomalies among those with rheumatological disease compared

with those without any disease.

Coauthor and maternal-fetal specialist Dr Aviva Lee-Parritz (Boston

Medical Center, MA) told rheumawire that the most important thing for

women with rheumatological diseases who want to become pregnant " is to

ensure that their disease is under control first, with a medication that

can safely be taken in pregnancy. If women start pregnancy with poor

disease control, they fare worse, " she noted.

Another vital issue is preconception counseling, she says.

" Rheumatologists must make sure these women know the risks associated

with pregnancy. "

Wolfberg and colleagues specifically set out to examine the association

of rheumatological disease with hypertension and preeclampsia, because

" there are limited data regarding this association. "

From a database, they identified 114 women with diagnosed

rheumatological disease who delivered a baby at their institutions

during a 33-month period and compared them with around 18 500 women who

had babies but did not have any rheumatological disease.

Those with rheumatological disease were more likely to have preeclampsia

than those without (8.8% vs 2.3%; p<0.001), although the risk was

statistically significant only for those with SLE and antiphospholipid

syndrome.

Those with autoimmune disease were also at increased risk of preterm

delivery (15.2% vs 7.8%; p=0.002) and SGA infants (8.0% vs 3.1%;

p=0.001) compared with women without rheumatological disease.

And chronic hypertension was more of a problem in those with disease,

but this was not unexpected, the researchers comment. " We show an

increased rate of chronic hypertension among women with rheumatological

disorders, a finding that is not surprising given that hypertension has

been associated with rheumatological disorders in patients who are not

pregnant. "

Lee-Parritz told rheumawire: " It's very important for lupus patients and

others to have their blood pressure and any end-organ damage assessed

before they embark on pregnancy or at the beginning of pregnancy. " This

is because it's often hard to discriminate between hypertension in

pregnancy and that normally associated with disease, she says. But there

is 1 way this can be done for lupus patients if there is uncertainty,

she saysby checking complement levels. " Usually complement levels are

altered in lupus but remain unchanged in preeclampsia. "

One final thing rheumatologists need to remember, says Lee-Parritz, is

to check pregnant women with Sjögren's syndrome for anti-Ro and anti-La

antibodies. Doctors tend to do this routinely in lupus patients but

forget in Sjögren's syndrome, she explained. Although these antibodies

are present in only a very small number of patients (less than 5%),

pregnant women with these antibodies have a higher risk of their baby

developing fetal congenital heart block and therefore need to be

monitored carefully, she noted.

In conclusion, the findings " suggest that women with rheumatological

diseases deserve extremely close monitoring during the antepartum and

intrapartum periods [and] suggest the possibility of a common

autoimmunological link between preeclampsia and rheumatological diseases

that is worthy of further research, " the researchers say.

Source

Wolfberg AJ, Lee-Parritz A, Peller AJ, et al. Association of

rheumatologic disease with preeclampsia. Obstet Gynecol 2004;

103:1190-1193.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org