Preconceptional Cardiovascular Health and Pregnancy Outcomes in Women with Systemic Lupus Erythematosus

Abstract

Objective: To estimate the effects of preconceptional cardiovascular (CV) health, measured by American Heart Association (AHA) guidelines, on pregnancy outcomes in women with systemic lupus erythematosus (SLE).

Methods: The study included patients in the Hopkins Lupus Pregnancy Cohort. Body mass index (BMI), total cholesterol, and blood pressure (BP) in the most recent clinic visit prior to conception or first trimester were used to determine CV health (ideal, intermediate, or poor health) based on AHA definitions. Outcomes included preterm birth, gestational age at birth, and small for gestational age (SGA). Multivariable linear and logistic regression models with generalized estimating equations estimated the association of each CV health factor and outcome.

Results: The analysis included 309 live births. There were 95 preterm births (31%), and of the 293 pregnancies with birth weights, 18% were SGA. Ideal BMI, total cholesterol, and BP were reported in 56%, 85%, and 51% of pregnancies, respectively. Intermediate BMI was associated with decreased odds of SGA (OR 0.26, 95% CI 0.11-0.63), adjusted for race and prednisone use. Intermediate/poor total cholesterol was associated with increased odds of preterm birth (OR 2.21, 95% CI 1.06-4.62). Intermediate/poor BP was associated with decreased gestational age at birth (β -0.96, 95% CI -1.62 to -0.29).

Conclusion: Poor/intermediate preconception CV health affects pregnancy outcomes of preterm birth and SGA infants among women with SLE. Efforts to maintain BMI, total cholesterol, and BP within the recommended ideal range prior to pregnancy is important to improve pregnancy outcomes in women with SLE.

Keywords: BIRTH WEIGHT; CARDIOVASCULAR DISEASES; PREGNANCY; PREMATURE BIRTH; SYSTEMIC LUPUS ERYTHEMATOSUS.

Figure 1

Preconceptional cardiovascular health according to American Heart Association criteria* in the Hopkins Lupus Pregnancy Cohort (n=309 pregnancies). *Body mass index: (1) poor health (obese): ≥30 kg/m²; (2) intermediate health (overweight): 25-29.9 kg/m²; (3) ideal health (low/normal BMI): <25 kg/m²; Total cholesterol: (1) poor health: ≥240 mg/dL; (2) intermediate health: 200–239 mg/dL or treated to goal; (3) ideal health: <200 mg/dL; Blood pressure: (1) poor health: Systolic ≥140 or Diastolic ≥90 mm Hg; (2) intermediate health: Systolic 120–139 or Diastolic 80–89 mm Hg or treated to goal; (3) ideal health: <120/<80 mm Hg