Background and aims Women with SLE are at greater risk of premature cardiovascular disease and adverse pregnancy outcomes including preterm delivery.
In the general population, preterm delivery is associated with an increased risk of maternal cardiovascular events (CVE).
Therefore, we sought to determine if preterm delivery was a surrogate marker for accelerated CVE in women with SLE.
Methods Utilising linked population-based registries from Sweden between 1973–2011, women with SLE born between 1951 – 1971 were included. Preterm delivery was defined as delivery <34 weeks’ gestation. Outcome was any CVE (i.e. coronary artery disease, stroke, peripheral vascular disease and death from these causes). Multivariate analysis adjusting for cardiovascular risk factors and SLE-related morbidity (inclusive of inpatient admissions, duration of SLE, renal disease, infection and cancer) was performed.
Results There were 3224 women, median age 49 years (IQR 44–54); 72% had a previous pregnancy and 6% had delivered <34 weeks’ gestation. The prevalence of CVE was 10.4%. Despite being of a similar age distribution, women with <34 week deliveries had longer duration of SLE, greater SLE-related morbidity and cardiovascular risk factors.
Those with <34 week deliveries had the highest incidence of CVE at the median age of 40.5 years. However, the non-parous group developed CVE earliest.
Conclusions The women with preterm deliveries <34 weeks displayed a more severe clinical phenotype of SLE; despite adjusting for these factors, they had an increased hazard of CVE with an accelerated rate of development of CVE compared to those who delivered later. Preterm delivery could be a surrogate marker for active SLE in pregnancy.
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