Infection vulnerability in pregnant women with and without systemic lupus erythematosus

Objective: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that predominantly affects females. SLE poses risks to the mother and fetus during pregnancy. Information on infection rates during pregnancy in patients with SLE is scarce. Therefore, this study assessed infection risk during pregnancy in women with and without SLE, and identified the factors influencing susceptibility to infections. Methods: We conducted a retrospective cohort analysis using medical records from Tawam Hospital, Abu Dhabi, United Arab Emirates. Emirati women diagnosed with SLE who experienced one or more pregnancies between January 2010 and August 2023 were included in the study. Patients with SLE were compared with an age-matched control group of women without SLE. The control group was systematically selected from the hospital records of the same period. Demographic details, clinical data, and comprehensive infection histories during and before pregnancy were examined. Univariate and multivariate regression analyses were used to identify the factors contributing to the risk of infection in pregnant women with SLE. Results: Data from 87 pregnancies in 41 women with SLE were analyzed. The mean age at conception was higher in women with SLE compared to the control group. The rates of infections (54.7% vs 29.8%), adverse fetal outcomes (48.3% vs 24.2%), and maternal outcomes (71.3% vs 43%) were significantly higher in the SLE group than in the control group. Respiratory infections were the most prevalent infection type. No variable was found to increase the risk of infection; however, hydroxychloroquine use during pregnancy was significantly associated with a reduced risk of infection. Conclusions: The risks of infection and adverse outcomes are significantly higher in pregnant women with SLE than in the non-SLE population. Hydroxychloroquine use during pregnancy was crucial in reducing infection risk. These findings underscore the need for targeted interventions and a multidisciplinary care approach to improve pregnancy outcomes in women with SLE.