BRIEF RESEARCH REPORT article
Front. Lupus
Sec. Reproductive Issues in Lupus
Volume 3 - 2025 | doi: 10.3389/flupu.2025.1473368
This article is part of the Research TopicReproductive Issues In Lupus, Antiphospholipid Syndrome And Other Autoimmune Rheumatic Diseases: Highlights From RheumaPreg2023View all 15 articles
Differences in gestational age at preterm birth can facilitate cardiovascular risk stratification in SLE
Provisionally accepted
- 1Counties Manukau District Health Board, Auckland, New Zealand
- 2King's College London, London, England, United Kingdom
- 3Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
- 4The University of Auckland, Auckland, Auckland, New Zealand
- 5Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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Pregnancy complications from maternal-placental syndrome (MPS) are associated with the accelerated development of cardiovascular events (CVE) in the parous cohort with SLE. Preterm birth may result from MPS, which is more common in SLE. The aim of this study was to determine if preterm birth stratified by gestational age increases the risk of CVE in SLE.Methods:Utilising Swedish population databases between 1973-2011, those who had been pregnant with SLE were identified and stratified into three groups: term (≥37+0 weeks), late preterm 34+0-36+6weeks and early preterm <34+0weeks births. The primary outcome was CVE or death from CVE. Risk of CVE was calculated and adjusted for SLE-related morbidity and cardiovascular risk factors. Results:Over the 38-year interval, there were 3,963 subjects, the prevalence of preterm birth was 20.9%. Prevalence of CVE was 10.4% (n=411), being highest in those who had given birth <34+0weeks. After multivariable adjustment, the risk of CVE was 1.8 (adjusted hazards ratio, HR 95% CI 1.3-2.5) in those who birthed <34+0weeks compared to others who had birthed at term. They also developed CVE earlier than those who birthed at later gestational ages. Conclusions:Early preterm birth < 34+0weeks conferred a two-fold increased hazard for accelerated development of CVE. Reassuringly, those who delivered at a later gestation did not exhibit a similar risk of premature CVE. Therefore, birth <34+0weeks, regardless of underlying cause, may be a useful screening question to identify parous persons with SLE who are at greater risk of early CVE.
Keywords: systemic lupus erythematosus, pregnancy complication, cardiovascular risk (CV risk), risk stratification, Preterm Birth, population-based, SLE pregnancy, Cardiovascular event
Received: 30 Jul 2024; Accepted: 05 Jun 2025.
Copyright: © 2025 Soh, Nelson-Piercy, Westgren, McCowan and Pasupathy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: May Ching Soh, Counties Manukau District Health Board, Auckland, New Zealand
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