Eudy AM, et al. - Experts evaluated the impact of pregnancy on disease flares in systemic lupus erythematosus using a large cohort of pregnant and non-pregnant women with lupus. The previous findings suggesting that the incidence of flare is increased during pregnancy and within the 3-months postpartum were supported in this study. Nonetheless, the risk of flare during and after pregnancy was seen to be mitigated by continuing hydroxychloroquine (HCQ).

Methods

• Authors collected the data in the Hopkins Lupus Cohort 1987–2015.
• They included the women aged 14–45 years with >1 measurement of disease activity.
• They classified the time-varying exposures as pregnancy, postpartum or non-pregnant/non-postpartum periods.
• Researchers defined the flares as: change in Physician Global Assessment (PGA)≥1 from previous visit and change in Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI)≥4 from previous visit.
• An estimation of HRs with bootstrap 95% Cis was conducted with stratified Cox model.

Results

• As per data, there were 1349 patients, including 398 pregnancies in 304 patients.
• Findings suggested an that there was an increased rate of flare defined by PGA during pregnancy (HR: 1.59; 95% CI 1.27 to 1.96); nonetheless, this effect was modified by hydroxychloroquine (HCQ) use, with the HR of flares in vs non-pregnant/non-postpartum periods estimated to be 1.83 (95% CI 1.34 to 2.45) for patients with no HCQ use and 1.26 (95% CI 0.88 to 1.69) for patients with HCQ use.
• In the 3-months postpartum, experts noted a similar elevation of the risk of flare among non-HCQ users, but not for women taking HCQ after delivery.