Risk of Perinatal Infection in Women with and without Systemic Lupus Erythematosus (SLE) and their Infants

Abstract

Introduction: Increased risk of adverse birth outcomes including preterm delivery is well described in women with systemic lupus erythematosus (SLE), but risk of infection in either mother or infant during the peripartum period is not well described. We conducted a population-based study to compare infection risk in women with and without SLE and their infants. Methods: Linked birth-hospital discharge data identified all 1,396 deliveries to women with an ICD9 code indicating SLE in Washington State during 1987-2013. 5,584 women without SLE were identified for comparison, frequency-matched on delivery year. Maternal and infant infection during the birth hospitalization, and for infants, infection-related re-hospitalization in the first 30 days of life, were identified using birth and hospital discharge records. Relative risks (RR) and 95% confidence intervals (CI) for infection outcomes were estimated using Mantel-Haenszel stratified analysis, with adjustment for relevant covariates. The effects of gestational age in the relationships of maternal SLE to infant outcomes were assessed to better understand other mechanisms for infection aside from prematurity. Results: Women with SLE were 1.51 times more likely (95% CI 1.29-1.77) to have an infection during the birth hospitalization and 1.23 times more likely (95% CI 1.09-1.40) to receive antibiotics during labor, although no increased risk was observed for chorioamnionitis specifically (RR 0.79, 95% CI 0.44-1.40). Infants of women with SLE had a RR for any infection during the birth hospitalization of 2.59 (95% CI 1.77-3.80) which was attenuated after adjustment for gestational age (RR 1.44, 95% CI 0.96-2.15). In general, RRs for neonatal infection, sepsis, and receipt of antibiotics were increased for infants of women with SLE, but these RRs were markedly attenuated after adjustment for gestational age. No increased risk of infection-related infant re-admission within 30 days was observed. Discussion: Women with SLE have increased risk of peripartum infections and antibiotic exposure. Their infants have a greater likelihood of infection during the neonatal period, although much of this association may be ascribed to increased risk of prematurity. Providers caring for pregnant women with SLE should be aware of the probable excess risk of infection in this maternal and neonatal population.