CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS: PREGNANCY AND BIRTH OUTCOMES IN ONTARIO

O065 / #407 Topic: AS18 - Pediatric SLE ABSTRACT CONCURRENT SESSION 11: PREGNANCY IN SLE 24-05-2025 10:40 AM - 11:40 AM Background/Purpose Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem, autoimmune disease. Pregnancy and birth outcomes of women diagnosed with cSLE are not well understood. Long-term follow-up of cSLE patients is required as patients transition from pediatric to adult rheumatology care. This present study uses a large province-wide cSLE cohort linked with multiple health administrative databases following cSLE patients from the time they were diagnosed (under 18 years old) into adulthood. Our objectives were to describe and evaluate pregnancy, neonatal, and maternal outcomes among females diagnosed with cSLE in Ontario; and to identify demographic and disease characteristics associated with adverse pregnancy and birth outcomes. Methods A population-based retrospective cohort study linked clinical data for eligible female patients diagnosed with cSLE between January 1985 and March 2011 and followed for ≥ 1 year from date of diagnosis to March 31, 2023 with multiple health administrative datasets housed at the Institute for Clinical Evaluative Sciences (ICES). We examined descriptive summaries of pregnancy, neonatal, and maternal outcomes. The primary outcome was fetal death (encompassing stillbirth, miscarriage, and abortion). Secondary outcomes included preterm birth, neonatal hospitalization and morbidity, and various maternal outcomes (Table 1). We used unadjusted and adjusted Generalized Estimating Equations (GEE) to estimate the association between study outcomes and demographic and early disease characteristics. Specifically, we adjusted for age at diagnosis, years since cSLE diagnosis, ethnicity, income, anti-dsDNA antibodies, and biopsy-proven lupus nephritis. Using GEE enabled us to account for within-mother clustering from additional pregnancies during the follow-up period Table 1: Pregnancy, neonatal, and maternal outcomes among female cSLE patients Results Our study included 489 female cSLE patients diagnosed with cSLE between 1985 - 2011 and followed for 16.8 ± 7.2 years (mean ± SD). A total of 423 pregnancies occurred in 175 women during the follow-up period. 131 (75%) women had at least one live birth while 44 (25%) had no live births. 195 (46%) pregnancies resulted in fetal death, 73 (32.0%) of live births were preterm, and 76 (33%) of neonates were admitted to neonatal intensive care (Table 1). Our adjusted analysis (Table 2) shows that patients who were older at time of cSLE diagnosis have lower odds of fetal death (OR 0.87; 95% CI 0.78-0.97). Our univariate analyses show that odds of preterm birth are higher for patients with non-White ethnicity (OR 2.43; 95% CI 1.22–4.85), anti-Sm antibodies (OR 2.82; 95% CI 1.43–5.56), and biopsy-proven lupus nephritis (OR 2.51; 95% CI 1.27–4.98). Table 2: Adjusted Analysis Model for Fetal Death Conclusions Investigating pregnancy, neonatal, and maternal outcomes is crucial for enhancing patient care and health resource management for cSLE patients. Age at diagnosis, non-White ethnicity, and early disease characteristics including anti-Sm antibodies, and biopsy-proven lupus nephritis are significantly associated with adverse pregnancy and birth outcomes.