Adolescents with systemic lupus erythematosus (SLE) are more likely than their healthy peers to have adverse pregnancy outcomes and have higher rates of pregnancy loss compared against adults with SLE, according to study results presented at the American College of Rheumatology (ACR) Convergence 2025, held from October 24 to 29, in Chicago, IL.
In response to limited data on pregnancy among adolescents with SLE, researchers examined adverse pregnancy outcomes among patients aged 21 years or less with and without SLE and adults (≥22 years old) with SLE. Deidentified electronic health record data were sourced from a system that included more than 3.8 million individuals.
A validated algorithm requiring at least 4 electronic billing codes was used to identify patients with SLE, with at least 1 pregnancy or delivery code used to identify those who were pregnant. Pregnancies that occurred before SLE diagnosis were excluded. Control individuals were those without codes for autoimmune diseases but with at least 1 pregnancy or delivery code.
The study included 32 pregnancies among 27 adolescent patients with SLE, 146 pregnancies among 90 adolescent control individuals without SLE, and 266 pregnancies among 182 adults with SLE.
Adolescents with SLE represent a high-risk pregnancy group that needs close monitoring.
Mean maternal age at delivery was 19 years for adolescent control individuals, 20 years for adolescents with SLE, and 30 years for adults with SLE. Adults with SLE were more likely to be White than either group of adolescents, and SLE pregnancies were more likely to be complicated by hypertension than non-SLE pregnancies (P <.001 for both comparisons).
Adolescents with SLE were more likely than their peers without SLE to develop preeclampsia (33% vs 6%; P <.001), postpartum hemorrhage (24% vs 3%; P =.001), and preterm delivery (56% vs 18%; P =.001), with no significant differences in pregnancy loss (elective termination, spontaneous abortion, or stillbirth), small for gestational age (birth weight <10th percentile for gestational age), gestational diabetes, or peripartum infection.
When comparing younger vs older patients with SLE, adolescents more frequently had antiphospholipid antibody syndrome (43% vs 21%; P =.01), nephritis (66% vs 34%; P =.001), and pregnancy loss (38% vs 21%; P =.02) compared with adults, with no differences among other pregnancy and fetal outcomes.
In mixed effects logistic regression models adjusted for age at delivery and race/ethnicity, the risks for pregnancy loss, preterm delivery, and preeclampsia were greatest among adolescents with SLE.
“Adolescents with SLE represent a high-risk pregnancy group that needs close monitoring,” the study authors concluded.
This article originally appeared on Rheumatology Advisor