Medication Use Among Pregnant Women With Systemic Lupus Erythematosus and General Population Comparators

Kristin Palmsten; Julia F. Simard; Christina D. Chambers; Elizabeth V. Arkema

Disclosures

Rheumatology. 2017;56(4):561-569. 

In This Article

Abstract and Introduction

Abstract

Objective. The aim was to characterize SLE medication trends before, during and after pregnancy and to compare other commonly used medications during SLE pregnancies with non-SLE pregnancies.

Methods. Women with pregnancies ending in live birth or stillbirth were identified from the Swedish Medical Birth Register (2006–12). National registers were used to identify women with prevalent SLE during pregnancy and a sample without SLE and to identify prescription medications dispensed from 3 months pre-pregnancy until 6 months postpartum. We reported the prevalence of DMARDs, systemic CSs and NSAIDs (aspirin reported separately) in SLE pregnancies. We calculated prevalence estimates of other medications that were dispensed during pregnancy to ≥ 5% of SLE pregnancies and for the same medications among non-SLE pregnancies.

Results. There were 483 pregnancies among women with SLE and 5723 pregnancies among women without SLE. In SLE pregnancies, 49.3% had one or more dispensing for DMARDs during pregnancy; the prevalence was 48.0% for CSs, 40.8% for aspirin and 6.0% for other NSAIDs and varied by pregnancy period. The prevalence of common medications among SLE pregnancies was 1.2- to 20-fold higher than among non-SLE pregnancies; for example, dalteparin (20.9 vs 1.0%), paracetamol (18.2 vs 2.9%) and levothyroxine (15.9 vs 4.9%).

Conclusion. In nearly half of SLE pregnancies, women were dispensed DMARDs and CSs. Commonly used medications in SLE pregnancies had far higher prevalence estimates compared with non-SLE pregnancies. Research regarding benefits and risks of commonly used medications on SLE pregnancies, breast milk and long-term outcomes for offspring is needed.

Introduction

The incidence of SLE is greatest among women of reproductive ages.[1] Decisions regarding medication use during pregnancy are crucial for women with this multisystem autoimmune disease. Treatment with immunosuppressants, CSs and NSAIDs during pregnancy may be indicated to treat flares or to keep disease activity under control.[2] Other medications may also be used during pregnancy to treat co-morbidities that are more common among individuals with SLE (e.g. APS, hypertension and depression).[3,4] The most prevalent prescription medications among pregnant women in general include antibacterials and antihistamines,[5] and these may also be used commonly in SLE pregnancies.

There is limited information regarding medication use among pregnant women with SLE. Most reports from the past 15 years are based on a few hundred women or less and are often from women who attended one health-care centre, which limits generalizability.[6–14] Previous reports tended to focus on medications used to treat SLE, including HCQ, AZA and CSs, and few addressed heparin or other medications.[6,8,11,13,15] There is limited information regarding the timing and trajectory of medication use before, during and, especially, after SLE pregnancies.[7,10,11,14,16] To our knowledge, no studies have compared medication use among pregnant women with SLE vs women without SLE. Besides rheumatologists, other physicians, including obstetricians and general practitioners, prescribe medications for pregnant women with SLE. The spectrum of commonly used medications among pregnant women with SLE may not be apparent to their health-care providers. A more holistic approach to studying medication use among pregnant women with SLE is needed to gain a better understanding of the medication counselling needs of women with SLE who are pregnant or are planning pregnancy.

We used population-based health register data from Sweden to address the limited information on medication use among pregnant women with SLE. We identified the most prevalent medications among SLE pregnancies, characterized pre-pregnancy, pregnancy and postpartum medication prevalence, and compared medication prevalence among SLE pregnancies with non-SLE pregnancies.

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