Pregnant women with systemic lupus erythematosus (SLE) have a significantly greater risk for pre-eclampsia compared to the general population. While previous research has found that aspirin may bring this risk down, a recent study showed that most at-risk women are not taking aspirin.
The present study, published in Annals of the Rheumatic Disease, included 475 pregnancies among 300 SLE patients aged between 18 and 45 years. Between 2000 and 2017, women attended at least one annual study visit, where researchers evaluated aspirin use, traditional pre-eclampsia risk factors (hypertension, chronic kidney disease, diabetes, nulliparity, body mass index ≥35, age >40), positive antiphospholipid antibodies (aPL), and active lupus nephritis. Mean disease duration at pregnancy time was 5.6 years.
— Dr Eugene Kongnyuy (@eugene_kongnyuy) January 4, 2019
Just over half (51%) of pregnancies had at least one traditional pre-eclampsia risk factor, and 33% had positive aPL. But aspirin was used in only a quarter of pregnancies. There were slight differences based on race: aspirin was used in about a third of pregnancies in Caucasian (34%, 95% CI 28% to 41%) and Hispanic (32%, 95% CI 22% to 45%) women, but in only 10% (95% CI 5% to 18%) and 11% (95% CI 5% to 20%) of black and Asian women, respectively. Rates of aspirin use did not differ in pregnancies with or without at least one traditional risk factor (25% [95% CI 20% to 31%] vs. 26% [95% CI 21% to 32%]), an individual traditional risk factor, or nephritis. Researchers observed a slight trend in aPL positive pregnancies and aspirin use (38%, 95% CI 24 to 55%) compared to non-aPL positive pregnancies (23%, 95% CI 15% to 34%), despite a CI overlap. Results were similar even when excluding for multiple pregnancies within the same women. Trends did not change throughout the study period.
“In conclusion, we have potentially identified an important gap between practices and current recommendations for the care of pregnant SLE women, and call for further studies of factors contributing to aspirin use in lupus pregnancies,” the researcher wrote.
Source: Annals of the Rheumatic Disease