Evaluation of preterm delivery in a systemic lupus erythematosus pregnancy clinic

Objective: To identify the primary etiology of preterm birth in women with systemic lupus erythematosus, analyzing prospective data collected on 66 pregnancies in 58 women followed-up at a lupus pregnancy center. Methods: Hospital records were reviewed and subjects were interviewed for pregnancies delivered after 23 completed weeks' gestation in women cared for at the Hopkins Lupus Pregnancy Center. A control group consisted of all women delivered at the same hospital during 2 years of the study period. Results: Preterm premature rupture of membranes (PROM) occurred in 13 of 33 (39%) pregnancies delivered at 24-36 weeks' gestation. In addition, term PROM also occurred with high incidence in ten of 33 (30.3%) pregnancies delivered after 36 weeks' gestation. The rate of PROM in study subjects differed from that in controls at 34-36 weeks' gestation and after 36 weeks. Conclusion: Premature rupture of membranes is more common in pregnancies occurring in women with systemic lupus erythematosus than in control pregnancies. Disease activity, prednisone use, and serologic studies are not predictive. Premature rupture of membranes is the major etiology of preterm birth in this cohort.