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Context: Understanding the obstetric outcomes in women with Systemic Lupus Erythematosus (SLE) continues to be an important area of research. Furthermore, understanding its impact on the fetal immune system is an emerging area of interest. Specific Aims: The specific aims of this dissertation were to 1) examine the obstetric outcomes of women with SLE in comparison to women without SLE in the United Kingdom (Study 1); and 2) to investigate whether infants born to women with SLE have a higher risk of infection, or of sepsis, when compared to infants born to women without SLE (study 2). Design, Setting and Subjects: The Clinical Research Practice Datalink (CPRD) – Gold, the Hospital Episode Statistics (HES) and Mother-Baby linkage data were used to gather women with SLE enrolled in the database since inception (1987) for studies 1 and 2. The population for study 1 was women who became pregnant after diagnosis with SLE. Live born infants of women with SLE were ascertained as the exposed population in study 2. Women without SLE were utilized as a control group for the retrospective cohort study 1, and infants born to mothers without SLE were used as a control group in the retrospective cohort study 2. Results: Study 1 showed an increasing trend of frequency of outcomes among the SLE population. Specifically, the frequency of caesarian section (25.8% vs. 22.5%), preterm birth (9.2% vs. 6.2%), miscarriage (18.7% vs. 16.8%), and stillbirth (0.7% vs. 0.4%) was higher among women with SLE. While most outcomes showed an approximate 15% increase in frequency compared
to women without SLE, preterm birth and stillbirth was 45% increased. After adjustment for maternal age, parity and birthweight, caesarian section remained the only adverse event with an increased risk for women with SLE ([Adjusted Risk Ratio (aRR)] aRR = 1.44, 95%CI: 1.06, 1.97). When stratified by type, women with SLE were at a higher risk of elective caesarian section compared to women without SLE (aRR = 1.90; 95% CI: 1.16, 3.11). Results from study 2 found that 15% of infants born to mothers with SLE had a general practitioner visit for infection in the first two years of life, compared to 12.3% of infants born to born to mothers without SLE (Risk Ratio (RR)= 1.11; 95%CI: 1.0, 1.4). Estimates adjusting for preterm birth and maternal age were similar (aRR = 1.24, 95% CI: 0.94, 1.62). The specific infection categories showing an increased risk in adjusted models were “other urinary tract infections” (aRR = 2.29; 95%CI: 1.00, 5.25) and “other bacterial infections” (aRR = 3.29; 95%CI: 1.00, 10.86). There was insufficient data to examine risk by time period. Infants of mothers with SLE were not at an increased risk for hospitalization due to infection or sepsis. Conclusion: Women with SLE are able to have successful pregnancy outcomes but are at higher risk for caesarian section (study 1). Infants to mothers with SLE do not appear to be at increased risk of infection overall but may be at a small increased risk of UTI and other bacterial infections (study 2). Further research is needed to clarify these associations.

ETD_10298

Ph.D.

Includes bibliographical references

doi:10.7282/t3-pnvy-xk11

ETD doctoral

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