Problem of Lupus During Pregnancy

Lupus may boost preeclampsia risk

(RxWiki News) When a woman becomes pregnant, she must be careful about what she puts in her body. If a pregnant woman is taking medications for a disease, she should know how those medications may affect her pregnancy.

In a recent study, pregnant women who used disease-modifying antirheumatic drugs (DMARDs) did not appear to have an increased risk of preeclampsia - a condition in which a pregnant woman develops high blood pressure and protein in the urine (a sign of kidney damage).

However, pregnant women with lupus - a disease often treated with DMARDs - did have a higher risk of preeclampsia than those without lupus.

"Pregnant? Talk to your doctor about all your prescription drugs."

Sonia Hernández-Diaz, MD, MPH, of Harvard School of Public Health, and colleagues set out to measure rates of DMARD use during pregnancy and to study the relationship between autoimmune diseases like lupus, drugs used to treat autoimmune disease and preeclampsia.

DMARDs are used to treat rheumatic diseases like rheumatoid arthritis and lupus. They act on the immune system to slow the progression of disease.

Non-steroidal anti-inflammatory drugs (NSAIDs) and steroids are also used to treat rheumatic diseases. Both types of drugs are used to reduce inflammation - one of the main characteristics of rheumatic diseases.

Dr. Hernándex-Diaz and colleagues found the rate of preeclampsia was lower among pregnant woman who used DMARDs than among those who used NSAIDs or steroids.

Specifically, the rate of preeclampsia was:

  • 2.3 percent among DMARD users
  • 2.7 percent among steroid users
  • 2.9 percent among NSAID users

Compared to women who used DMARDs before pregnancy, those who used DMARDs during pregnancy were 2.29 times more likely to develop preeclampsia. However, the higher preeclampsia risk associated with DMARDs was weakened when antimalarial drugs were excluded from the analysis.

Antimalarial drugs are used to treat malaria - an infectious disease that comes from mosquitos. They are also used to treat pain and inflammation of rheumatic diseases.

The researchers also found that the risk associated with DMARDs disappeared when their analysis included only women with autoimmune disease.

Lupus during pregnancy increased the risk of preeclampsia. Compared to women without any autoimmune disease, women with lupus were a little more than two times more likely to develop preeclampsia.

These findings suggest the higher risk initially seen in DMARD users may have less to do with their medications and more to do with the severity of their disease.

According to the authors, the preeclampsia risk is likely due to greater disease severity in DMARD users.

The study included 44,786 women with and without autoimmune disease. Only 414 of these women (0.1 percent) used DMARDs during pregnancy.

The research was funded by the National Institute of Child Health and Human Development, the Agency for Healthcare Research and Quality and the U.S. Department of Health and Human Services.

The study's authors reported potential conflicts of interest for receiving fees or research support from AstraZeneca, Novartis, GlaxoSmithKline Biologicals, Abbott, Amgen, Lilly, Sanofi-Aventis, Pfizer and Asisa.

The study was published October 30 in Arthritis Care & Research.

Reviewed by: 
Review Date: 
November 1, 2012