Hypertensive disease in pregnancies complicated by systemic lupus erythematosus

Robert S Egerman, Risa D Ramsey, Lu W Kao, Jay J Bringman, Andrew J Bush, Jim Y Wan
American Journal of Obstetrics and Gynecology 2005, 193 (5): 1676-9

OBJECTIVE: The purpose of this study was to assess the percentage of hypertensive disease in pregnancies complicated by systemic lupus erythematosus at a single institution.

STUDY DESIGN: We conducted a retrospective analysis of medical records between 1992 and 2003 of 68 pregnancies that were complicated by systemic lupus erythematosus from 48 parturients. Patients were categorized into 3 groups: no chronic hypertension (n = 49 women), chronic hypertension-no medication (n = 6 women) and chronic hypertension-treated (n = 13 women). Analyses of variance (with Tukey-Kramer adjusted follow-up evaluation) and chi-squared/Fisher's exact tests were used for the analyses of continuous and categoric variables, respectively. Significance was defined by a probability value of < or = .05.

RESULTS: Chronic hypertension complicated 28% of systemic lupus erythematosus pregnancies. Mean systolic blood pressures at intake were significantly different between the normotensive and no chronic hypertension groups and between the chronic hypertension-no medication and chronic hypertension-treated groups; the differences in diastolic pressures reached significance only between the no chronic hypertension and the chronic hypertension-treated groups. Maternal age, gestational age at delivery, birth weight, lowest platelet count, and highest serum creatinine levels were similar between the hypertensive and the nonhypertensive groups. There were no differences in the percentage of aspirin or heparin treatments among the groups, but the percentage of the chronic hypertension-treated group who received steroids was significantly greater than the percentage of women who received steroids in the other 2 groups (P < .05). Preeclampsia developed in 23% of the no chronic hypertension pregnancies and in 32% of the hypertensive pregnancies (P = .54). When pregnancies that were treated with prednisone (n = 34 pregnancies) were compared with those pregnancies that were managed with other agents (n = 34 pregnancies), the percentages of preeclampsia were similar (26% and 24%, respectively; P = .78).

CONCLUSION: The percentage of parturients with systemic lupus erythematosus in whom preeclampsia develops is increased, regardless of the presence of underlying chronic hypertension. Prednisone therapy was not associated with a higher risk of preeclampsia in this series.

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