Learning Objective #1: Identify differences in maternal risk factors related to lupus erythematosis in diverse populations

Learning Objective #2: Discuss strategies to modify adverse maternal outcomes among women with lupus across the three major ethnic groups in the United States

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Research Objective: Little research has been done on racial disparity and adverse maternal outcomes among women with lupus. Therefore, the objective of this study is to examine differences in adverse maternal outcomes among pregnant women with lupus across three major ethnic groups in the U.S.

Theoretical Base: Vulnerability as modified by cultural sensitivity and cultural competence were the organizing constructs.

Population Studied: A total of 790 lupus patients identified from 1,058,840 pregnant women aged 16 to 45 who delivered in 1998 and 1999, obtained from the National Inpatient Sample.

Study Design: Race/ethnicity was categorized as white (65%), African American (24%) and Hispanic (10%). Fourteen adverse maternal outcome measures were examined: pre-term labor, hypertensive disorders of pregnancy (preeclampsia, transient hypertension of pregnancy, pregnancy induced hypertension), gestational diabetes, antepartum hemorrhage (placenta previa, abruptio placenta), membrane disorders (premature rupture of membranes, infection of amniotic cavity), cesarean section, postpartum hemorrhage, fetal death, uterine tumor and pregnancy longer than 42 weeks. Maternal age and comorbidities were adjusted.

Principal Findings: In comparison to non-Hispanic white women, African-American women had as much as twice the risk of having transient hypertension of pregnancy (Odds Ratios [ORs] 2.03) and pregnancy-induced hypertension (OR 1.98), respectively. Hispanic women had comparable outcomes to those of white women.

Conclusions: Except that African American women have a higher risk of hypertension and preterm labor, racial disparities in maternal outcomes among women with SLE were not observed.

Implications for Policy, Delivery, and Practice: Pregnant women with SLE should have access to information, preventive treatment and appropriate education that targets the reduction of hypertension and preterm labor. Interventions should include early and continued access to culturally appropriate prenatal care. Prenatal education should include an emphasis on lifestyle changes including proper diet, rest, exercise, and anticipatory management of SLE symptoms.

Funding: Agency for Healthcare Research and Quality