RESEARCH - Rheumatic disease increases risks in pregnancy

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11/14/05 News Release

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RHEUMATIC DISEASE INCREASES RISKS IN PREGNANCY, STANFORD STUDY FINDS

STANFORD, Calif. - The first nationwide study of pregnancy outcomes in women

with rheumatic disease confirms that they experience greater pregnancy risks

and longer hospital stays than the average pregnant woman. The findings from

the Stanford University School of Medicine provide women who have these

conditions with a better understanding of the risks they face if they become

pregnant and underscores the need for physicians to monitor closely their

care.

The author of the study, Eliza Chakravarty, MD, assistant professor of

medicine (immunology and rheumatology), will present her findings Nov. 15

during a scientific poster session at the American College of Rheumatology

annual scientific meeting in San Diego.

Tina Chambers, MD, professor of pediatrics at the University of

California-San Diego, who was not involved in this study, said the findings

fill a troubling gap in what is known about pregnant women who suffer from

these autoimmune conditions. " Intuitively, you would think that it would be

easy to access [such] data, " she said, " but there is little to nothing in

the literature about rheumatoid arthritis or lupus in pregnant women. "

(Chambers has collaborated with Chakravarty on other projects.)

In this study, Chakravarty aimed to see how the pregnancy outcomes for these

women would compare with the outcomes for healthy women and women with

diabetes. " Nobody knew these numbers, " she said.

In autoimmune diseases such as lupus or rheumatoid arthritis, the immune

system turns against parts of the body it is designed to protect, leading to

inflammation and damage to joints. More than 2 million Americans have

rheumatoid arthritis, while another 500,000 suffer from lupus. According to

the National Institute of Arthritis and Musculoskeletal and Skin Diseases,

rheumatoid arthritis and lupus affect far more women than men, leading

researchers to believe that hormonal factors may prompt their onset.

Chakravarty was able to determine the incidence of lupus and rheumatoid

arthritis pregnancies by sifting through records of pregnancies and

deliveries using the Nationwide Inpatient Sample, a database of hospital

discharge summaries from the entire country. In 2002, the latest year in

which data was available, she found that at least 4,000 of the approximately

4 million total deliveries occurred in women with lupus or rheumatoid

arthritis. By comparison, about 13,000 women who delivered in 2002 had

diabetes.

" Women with rheumatoid arthritis are typically somewhat older when they

become pregnant, " said Chakravarty. " However, even after adjusting for

maternal age, they run a higher risk for adverse outcomes and generally

experience longer hospital stays than other women. " On average, hospital

stays increased from about two days for the general population to between

three and four days for the rheumatoid group.

Chakravarty's findings also show that, compared with the general population,

women with lupus or rheumatoid arthritis are three times as likely to

develop hypertension and one-and-one-half times as likely to have cesarean

deliveries or deliver prematurely.

In a previous study, Chakravarty had gathered evidence on the effects of

lupus in 63 pregnant women at Stanford. Her results revealed that more than

half of the deliveries were premature, and one-fifth suffered from

pre-eclampsia-a condition characterized by a sharp rise in blood pressure

during the third trimester of pregnancy. Her new study shows that the

problems suffered by the women at Stanford are similar to what women

experience nationwide.

" Until now, all studies have been reported from a single center, " said

Chakravarty. " I wanted to know, is this what happens across the country? "

http://mednews.stanford.edu/releases/2005/november/rheumatic.html

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org