Racial differences in cardiovascular events and adverse pregnancy outcomes among pregnant individuals with SLE.

OBJECTIVE

We aimed to characterise differences in the occurrence of maternal cardiovascular events (CVEs) and adverse pregnancy outcomes (APOs) in each of four racial/ethnic groups compared with non-Hispanic white women with SLE and to evaluate whether the relationship between CVEs and APOs differed across or within racial/ethnic groups.

METHODS

Using a California population-based birth cohort (2005-2020), we identified pregnant individuals with SLE via International Classification of Diseases codes from maternal discharge records. Self-reported racial/ethnic groups were categorised as Asian, Hispanic, non-Hispanic black, non-Hispanic white and other. Individuals with reported race or ethnicity as 'Нет данных' or 'not stated' were excluded from the study. Log-linear regression estimated adjusted relative risks (aRRs) of CVEs and APOs in each racial/ethnic group compared with non-Hispanic white individuals, adjusting for a propensity score derived from maternal age, payer, education, comorbidities and SLE-related variables. We performed CVE-stratified analyses for racial/ethnic differences in APOs and examined associations between CVEs and APOs within each racial/ethnic group.

RESULTS

Among 8188 liveborn singletons from women with SLE, non-Hispanic black women had the highest prevalence of maternal CVEs (4.0% vs 1.6-2.0% in other groups), maternal APOs (24.6% vs 13.5-17.2%) and infant APOs (54.6% vs 34.6-49.4%). Relative to non-Hispanic white women, non-Hispanic black women had an aRR of 1.6 (95% CI 0.9 to 2.6) for maternal CVEs and 1.3 (95% CI 1.1 to 1.6) for maternal APOs, whereas infant APO risks were significantly higher across three of four racial/ethnic groups compared with non-Hispanic white women.

CONCLUSIONS

Non-Hispanic black women exhibited the highest absolute burden for the adverse outcomes studied. Relative to non-Hispanic white individuals, elevated adjusted risks based on race/ethnicity were most consistent for infant APOs, whereas elevated risks for maternal APOs and CVEs were found primarily among non-Hispanic black individuals. Social drivers of health need consideration while caring for pregnant individuals with SLE.