The importance of pregnancy planning in lupus pregnancies

被引:23
作者
Rajendran, Aardra [1 ]
Eudy, Amanda M. [1 ]
Balevic, Stephen J. [1 ]
Clowse, Megan E. B. [1 ]
机构
[1] Duke Univ, Med Ctr, 3535,200 Trent Dr, Durham, NC 27710 USA
关键词
Pregnancy; systemic lupus erythematosus; antiphospholipid syndrome; UNINTENDED PREGNANCY; CHILD HEALTH; WOMEN; AMBIVALENCE; PREVALENCE; INTENTIONS; BEHAVIOR; INFANT;
D O I
10.1177/0961203321989803
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective In seeking new approaches to improve lupus pregnancy outcomes, we study the association between pregnancy planning, behaviors recommended by American College of Rheumatology's Reproductive Health Guideline 2020, and pregnancy and infant outcomes. Methods Lupus pregnancies in a prospective registry (1/1/2018 to 4/1/2020) were classified as planned or not-planned using the patient-reported London Measure of Unplanned Pregnancy. These groups were compared for demographics, pre-pregnancy disease activity, pregnancy planning behaviors, and delivery outcomes. Results Among 43 women with 43 singleton pregnancies the average age was 29.4 years and 42% were Black. Overall, 60% were planned pregnancies and 40% were not-planned (16 ambivalent, 1 unplanned). Women with not-planned pregnancies had lower age, income, and education, and more required Medicaid. Women with not-planned pregnancies were more likely to conceive when lupus activity was higher (p = 0.001), less likely to receive pre-pregnancy counseling with a rheumatologist (p = 0.02), and less likely to continue pregnancy-compatible medications (p = 0.03). Severe PROMISSE adverse pregnancy outcomes (APOs) and severe neonatal outcomes were higher among women with not-planned than planned pregnancies (43% vs 0% p = 0.003; 70% vs 30% p = 0.06). Conclusion This study identifies pregnancy intention as a potentially modifiable risk factor for poor outcomes in women with lupus. It highlights a unique population of women with lupus at high risk for pregnancy and infant complications: those ambivalent about pregnancy. These women may not be effectively engaging in health behaviors that prevent pregnancy nor those that will prepare for a safe pregnancy. With effective pregnancy planning and contraception guidance, we may decrease their risk for maternal-fetal morbidity and mortality.
引用
收藏
页码:741 / 751
页数:11
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