Gestational weight gain and pre-conceptional cardiovascular health in pregnant women with systemic lupus erythematosus Public Deposited

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  • March 20, 2019
Creator
  • Eudy, Amanda
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Systemic lupus erythematosus (SLE) is an autoimmune disease largely affecting women of childbearing age. Compared to the general population, SLE patients have a higher risk of poor pregnancy outcomes. We investigated three aspects of pregnancy in SLE patients in the Hopkins Lupus Pregnancy Cohort: a) weight gain during pregnancy, b) preconceptional cardiovascular health as a risk factor for pregnancy outcomes, and c) the effect of pregnancy on disease activity. For the analysis of gestational weight gain (GWG), of the 211 pregnancies with available data, 34%, 24%, and 42% had inadequate, adequate, and excessive GWG, respectively, based on pre-pregnancy BMI, according to Institute of Medicine (IOM) guidelines. In exploratory analyses, differences in IOM adherence were observed by pre-pregnancy BMI, race, elevated creatinine, and pre-pregnancy blood pressure. Odds of inadequate and excessive GWG increased 12% with each 1 kg/m2 increase in pre-pregnancy BMI. Lower maternal education was associated with increased odds of inadequate and excessive GWG. Next, we analyzed 308 births with available preconceptional cardiovascular data, of which 56% had ideal BMI (<25 kg/m2), 86% ideal total cholesterol (<200 mg/dL untreated), and 51% ideal blood pressure (<120/<80 mm Hg untreated). In adjusted models, overweight was associated with decreased odds of small for gestational age (OR: 0.26; 95% CI: 0.11, 0.63) compared to ideal weight, intermediate/poor total cholesterol was associated with increased odds of preterm birth (OR: 1.91; 95% CI: 0.96, 3.79), and intermediate/poor blood pressure was associated with decreased gestational age at birth (β: -0.96; 95% CI: -1.62, -0.29). Finally, due to adverse effects of flares on pregnancy outcomes, we estimated rates of flares during pregnancy and a 1-year postpartum period compared to unexposed periods. We observed an increased rate of flares during pregnancy in stratified Cox models for PGA flare (HR: 1.59; 95% CI: 1.27, 1.96) and SELENA SLEDAI flare (HR: 1.57; 95% CI: 1.25, 1.92). The HR of flares during pregnancy compared to unexposed periods was modified by hydroxychloroquine use. Our results demonstrated the need for interventions to improve GWG guideline adherence and pre-conceptional cardiovascular health, and the importance of continuing to monitor SLE patients for flares during pregnancy.
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  • In Copyright
Advisor
  • Engel, Stephanie
  • Franceschini, Nora
  • Clowse, Megan
  • Howard, Annie Green
  • Siega-Riz, Anna Maria
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016
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