Pregnancy may not increase the risk of a cardiovascular event (CVE) in women with systemic lupus erythematosus as much as disease-related morbidities, according to findings from a large, retrospective study presented at the European Congress of Rheumatology.

In fact, uncomplicated pregnancy may be a positive marker for later cardiovascular health in lupus patients, Dr. May Ching Soh reported at the meeting.

“Physicians and patients may derive some reassurance that perhaps a pregnancy uncomplicated by maternal-placental pathology may be associated with lower risk for future cardiovascular events,” Dr. Soh said in an interview. “However, we cannot at this time recommend relaxing on our laurels and not screening and actively managing cardiovascular risk factors in all patients with systemic lupus erythematosus.”

Dr. Soh, an obstetrician in the Women’s Centre at Oxford Radcliffe Hospital, part of the Oxford (England) University Hospitals NHS Trust, extracted data from linked Swedish population registries on systemic lupus erythematosus (SLE) patients’ parity status, the occurrence of features of maternal-placental syndrome (MPS, defined as hypertensive disorders of pregnancy, small-for-gestational-age, stillbirth, and placental abruption), SLE-related morbidities (in-patient admissions, renal disease, malignancies, and infections), and CVE outcomes (coronary artery disease, stroke, peripheral vascular disease, and death from these causes).

The final cohort comprised 3,232 women with SLE who had been born in 1951-1971. A total of 72% had children.

The mean age at follow-up was 49 years. Nulliparous women had more SLE-related morbidities, more cardiovascular risk factors, and more cardiovascular events than did parous women.

CVEs were most common among those women who had never given birth (3.4 per 1,000 person-years), followed by women with pregnancies complicated by MPS (2.8 per 1,000 person-years). Compared with women who had an uncomplicated pregnancy, the risk of a CVE was doubled in the nulliparous group (hazard ratio, 2.2) and close to double in the MPS-pregnancy group (HR, 1.8).

The time to first CVE also was significantly delayed in women who had uncomplicated pregnancies. By age 30, almost none had occurred in these women, but 5% of those with MPS-complicated pregnancies and 10% of the nulliparous women had experienced an event by that age. The separation continued as women aged. By age 40, an event had occurred in about 4% of the MPS-free women, 8% of the MPS group, and 10% of the nulliparous group. The rates at age 45 were 5%, 8%, and 15%, respectively.

“Our nonparous cohort did develop cardiovascular events earlier, but the MPS cohort also had accelerated development compared to the women who had uncomplicated pregnancies,” Dr. Soh said. “In fact, an adverse pregnancy outcome should serve as a red flag for physicians to start screening early for cardiovascular disease and actively managing risk factors.”

She had no financial disclosures.

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