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Stillbirth associated with increased lupus risk

Tuesday June 2nd 2020

Women who have had a stillbirth are four times more likely to develop lupus than those who had an uncomplicated live-birth, a new UK study has found.

Researchers at the University of Manchester found a link between stillbirth and connective tissue disorders, although lupus had the strongest association, and showed that the presence of antibodies – one of the first signs of the disease – could appear up to five years after stillbirth without symptoms.

The team used the Clinical Practice Research Datalink, which collects anonymised patient data from a network of GP practices across the UK, to study more than 100,000 mothers to see if those who had experienced stillbirth went on to develop lupus, connective tissue disease (CTD), or anti-phospholipid syndrome or antibodies.

Their findings are published in the British Journal of Obstetrics and Gynaecology.

Lead author Dr Hannah Kither, of The University of Manchester and obstetrician at Royal Bolton NHS Trust, said: “Stillbirth leaves both a psychological and a biological legacy; this study shows quite conclusively that these women have an increased risk of developing lupus.

“We think that either the stillbirth is a result of underlying immunological abnormalities akin to that seen in lupus or that the stillbirth itself triggers a cascade of immune reactions in the maternal system culminating in CTD in later life.

“The impact of stillbirth is traumatic- and the worries over having complications later on will be doubly hard for these women.”

Professor Alex Heazell, a researcher at the University of Manchester, and consultant obstetrician and director of the Tommy's Stillbirth Research Centre at Saint Mary's Hospital, added: “As stillbirth is now a known risk factor for lupus, GPs should be aware of this when seeing their patients’ investigation results. Women themselves should also be vigilant and look out for symptoms of Lupus which include joint pain, muscle pain and chronic fatigue.”

Tommy’s CEO Jane Brewin commented: “This study gives a strong steer that pregnant women should be tested early on for lupus and other related diseases, so that doctors can keep a close eye on anyone at risk throughout their pregnancy and beyond.

“We know that both lupus and baby loss are more common in BAME communities, but previous investigations of the link between these issues have come from countries that aren’t as diverse as the UK, so this study gives us a really important new insight. That said, it can’t tell us whether connective tissue disorders were the cause or the result of stillbirth – so we need more in-depth research to unpick that relationship, which is why Tommy’s set up the Manchester LIPS clinic with Sparks.”

Kither H, Heazell A, Bruce IN et al. Adverse pregnancy outcomes and subsequent development of connective tissue disease in the UK: an epidemiological study. BJOG. March 2020

https://doi.org/10.1111/1471-0528.16191

Tags: Childbirth and Pregnancy | Rheumatology | UK News | Women's Health & Gynaecology

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