Quinn Deirdre A, Sileanu Florentina E, Procario Gregory T, Mitchell Shannon, Birru Talabi Mehret
Center for Healthcare Evaluation, Research, and Promotion, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania.
Center for Healthcare Evaluation, Research, and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
ACR Open Rheumatol. 2025 Sep;7(9):e70100. doi: 10.1002/acr2.70100.
To describe severe maternal morbidity (SMM) among veterans with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) who use Department of Veterans Affairs (VA) health care.
We conducted a secondary analysis of VA national administrative data to compare rates of SMM among veterans with and without SLE or RA. Our sample included veterans aged 18 to 45 years who had at least one pregnancy between October 2009 and September 2019 and at least one documented VA primary care visit within the year before pregnancy. International Classification of Diseases, Ninth and Tenth Revision codes were used to identify SLE, RA, and medical and mental health comorbidities within two years before pregnancy. SMM was assessed using Centers for Disease Control and Prevention definitions and included events during and up to 42 days after pregnancy.
Among 29,713 veterans, 113 had SLE, and 92 had RA. Of these veterans, 36% with SLE and 30.4% with RA experienced a nonlive birth outcome, including stillbirth, ectopic pregnancy, and spontaneous abortion, compared with 25.2% of other veterans. Nearly 10% of veterans with SLE and 4.3% of veterans with RA experienced SMM, compared with 3.2% of other veterans.
To our knowledge, this is the first study of SMM among veterans with SLE and RA. Veterans with SLE appear to have an elevated risk of SMM, and veterans with SLE and RA appear to have high rates of pregnancy loss. Our findings highlight the potential utility of comprehensive maternity care models for these veterans with SLE and RA within the VA health care system.
描述使用退伍军人事务部（VA）医疗保健服务的系统性红斑狼疮（SLE）或类风湿关节炎（RA）退伍军人中的严重孕产妇发病率（SMM）。
我们对VA国家行政数据进行了二次分析，以比较患有和未患有SLE或RA的退伍军人中SMM的发生率。我们的样本包括年龄在18至45岁之间、在2009年10月至2019年9月期间至少有一次怀孕且在怀孕前一年内至少有一次VA初级保健就诊记录的退伍军人。使用国际疾病分类第九版和第十版编码来识别怀孕前两年内的SLE、RA以及医疗和心理健康合并症。使用疾病控制和预防中心的定义评估SMM，包括怀孕期间及产后42天内的事件。
在29713名退伍军人中，113人患有SLE，92人患有RA。在这些退伍军人中，患有SLE的36%和患有RA的30.4%经历了非活产结局，包括死产、宫外孕和自然流产，而其他退伍军人的这一比例为25.2%。患有SLE的退伍军人中近10%以及患有RA的退伍军人中4.3%经历了SMM，而其他退伍军人的这一比例为3.2%。
据我们所知，这是第一项关于患有SLE和RA的退伍军人中SMM的研究。患有SLE的退伍军人似乎SMM风险升高，患有SLE和RA的退伍军人似乎有较高的流产率。我们的研究结果凸显了在VA医疗保健系统中为这些患有SLE和RA的退伍军人提供全面孕产妇护理模式的潜在效用。
