Pregnancy Risks With Lupus and Rheumatoid Arthritis

Study Of Pregnancy Outcomes In Women With Rheumatic Disease Completed

Lupus and rheumatoid arthritis are both autoimmune diseases, so-called because a person's immune system, which normally helps protect the body from infection and disease, attacks itself.

Women with systemic lupus erythematosus and rheumatoid arthritis do experience more pregnancy complications and longer hospitalizations than women in the general obstetric population, according to the first study of its kind presented at the ACR Annual Scientific Meeting.

What Is Lupus?

Systemic lupus erythematosus is the disease that most people are referring to when they say "lupus." The word "systemic" means the disease can affect many parts of the body. In systemic lupus erythematosus, the body's immune system does not work as it should.

Lupus is a complex disease, and its cause is still unknown. Lupus can affect many parts of the body, including the:

  • joints
  • skin
  • internal organs

Symptoms vary, but may include a skin rash, arthritis, fever, anemia, fatigue, hair loss, mouth sores, and kidney problems. Symptoms of lupus can be mild or serious.

Pregnancy For Women With Systemic Lupus Erythematosus

Years ago, women with lupus were often counseled not to become pregnant because of the risk of a flare of the disease and an increased risk of miscarriage. The fear of miscarriage is very real for many pregnant women with systemic lupus. Lupus anticoagulants are also found in women with systemic lupus. However, thanks to advancements and careful treatment, more and more women with lupus can have successful pregnancies.

Most women with lupus are no longer cautioned to avoid pregnancy. Although lupus pregnancies are still considered high risk, many women carry their babies safely to the end of their pregnancy. Some women may experience a flare of symptoms during or after their pregnancy. According to NIAMS, pregnancy counseling and planning before pregnancy is important. A woman with lupus who becomes pregnant also needs to work closely with both her obstetrician and her lupus doctor. As a team, they can work together to evaluate individual needs and circumstances.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. Some people with rheumatoid arthritis also have symptoms in places other than their joints. Symptoms differ from person to person and can be more severe in some people than in others.

Pregnancy For Women With Rheumatoid Arthritis

Although individual advice will vary, women with rheumatoid arthritis are often counseled that pregnancy can be handled with special attention to medications and physical therapies.

Women with rheumatoid arthritis do have a statistically greater chance of premature births and neonatal complications, although experts disagree on exact numbers. There is also greater chance of miscarriage and a small possibility of congenital abnormalities.

In some cases, symptoms of rheumatoid arthritis are relieved during pregnancy. Unfortunately, these improved symptoms do not continue after the pregnancy is over. A flare in the disease can occur a few weeks after the baby is born.

Why This Study?

Although it is known that women with rheumatic disease have greater numbers of pregnancy complications, no nationwide study has compared the maternal and fetal outcomes of these pregnancies with that of the general obstetric population.

About The Study

Using the Nationwide Inpatient Sample, a nationally-recognized database of discharge records from representative U.S. hospitals, researchers estimated a total of just over 4 million deliveries in 2002. Of these deliveries:

  • approximately 3,264 deliveries occurred in women with systemic lupus erythematosus
  • approximately 1,425 deliveries occurred in women with rheumatoid arthritis

Researchers then compared both of these groups pregnancy outcomes and hospitalizations with that of the general obstetric population.

Study Results

Patients with systemic lupus erythematosus had twice the rate of hypertensive disorders that women with rheumatoid arthritis faced, and both exceeded those occurrences in the general population. The two patient groups also had higher rates of intrauterine growth restriction (poor fetus growth) and cesarean deliveries.


Women with either systemic lupus erythematosus or rheumatoid arthritis do run a higher risk for adverse outcomes and generally experience longer hospital stays than other women. As a result, they should be monitored carefully for the length of their pregnancies.

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