Systemic lupus erythematosus (SLE) primarily affects women during their reproductive years. African American women are at 3 times the risk of SLE compared with white women. Historically, women with SLE were advised against becoming pregnant. More recently, medical advice focuses on timing pregnancy to periods when SLE is well-controlled. Research suggests that women with SLE may be at risk of poor birth outcomes, but African American women have been underrepresented in these studies. Further, individuals with SLE are at high risk for cardiovascular disease (CVD) and adverse birth outcomes are associated with later CVD in the general population. The association between birth and pregnancy outcomes and later CVD health in women with SLE has not been examined. The overall goal of this dissertation is to characterize the associations between pregnancy and cardiovascular health among African American women with SLE.
In Aim 1, we will evaluate the association between SLE and the pregnancy outcomes preterm birth and small-for- gestational age (SGA) among African American women.
In Aim 2, we will examine whether African American women with SLE who gave birth are more likely to be hospitalized for CVD compared to African American women with SLE who never gave birth. Finally, in Aim 3, we will examine whether African American women with SLE who had adverse birth outcomes or maternal complications are more likely to be hospitalized for CVD compared to African American women with SLE who did not have any of these complications during pregnancy. This research will use data from both the Georgia Lupus Registry (GLR) and the Georgians Organized Against Lupus (GOAL) Cohort.
In Aim 1, female participants in GLR/GOAL will be linked to Georgia birth certificates on which they are identified as the mother. A comparison set of birth certificates to women without SLE will also be identified. The risk of preterm birth and SGA birth will be compared for women with and without SLE using log-risk regression models. Risks both before and after clinical diagnosis of SLE will be examined.
For Aims 2 and 3, hospitalizations for CVD and deaths attributable to CVD will be identified for GLR/GOAL participants using linked Georgia hospital discharge data and death records.
In Aim 2, we will compare the hazard of CVD among women with SLE who have given birth to women with SLE who have not given birth using Cox proportional hazards regression models.
In Aim 3, we will compare the hazard of CVD among women with SLE who gave birth and had adverse birth outcomes or maternal complications to women with SLE who gave birth but did not have adverse birth outcomes or maternal complications using marginal Cox models. As treatments and life expectancy for SLE improve, more of the estimated 200 per 100,000 African American women living with SLE will attempt pregnancy and childbearing. This research has the potential to contribute to informing the care and management of women with SLE before and after pregnancy.
Systemic lupus erythematosus (SLE) disproportionately affects reproductive-aged, African American women and is associated with an increased risk of cardiovascular disease. Research on the associations between pregnancy and cardiovascular disease in women with SLE is lacking, despite evidence of a connection between adverse birth outcomes and cardiovascular disease in the general population. The proposed research will examine the risks of adverse birth outcomes, both before and after clinical diagnosis of SLE, and the risks of cardiovascular disease after pregnancy in a cohort of African American women with SLE.
