P76 Low dose aspirin to prevent pre-eclampsia in SLE pregnancies – counselling helps to realize our full potential. (23rd March 2020)

• Record Type: Journal Article
• Authors: Haase, Isabell; Schneider, Matthias; Brinks, Ralph; Fischer-Betz, Rebecca
• Is Part Of: Lupus science & medicine. Volume 7(2020)Supplement 1
• Page Start: A65
• Page End: A66
• Publication Date: 2020-03-23
• Subjects: Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1136/lupus-2020-eurolupus.121
• Languages: English
• ISSNs: 2398-8851

Abstract

Abstract : Background: Women with Systemic Lupus Erythematosus (SLE) face a higher risk of pre-eclampsia, especially those with additional risk factors. Low dose aspirin (LDA) is known to protect against pre-eclampsia in non-autoimmune patients. Consequently, the EULAR recommends starting LDA in those women at risk preconceptionally or latest until gestational week 16. We sought to examine the use of LDA in a real-world cohort in relation to different risk factors and the provision of preconception counselling. Methods: Pregnancies of women with SLE from an outpatient pregnancy clinic were evaluated before and throughout pregnancy. Clinical characteristics including pre-eclampsia risk factors, disease activity (SLEDAI) and medication use were analysed. Association of Aspirin use (latest from week 16 on) with different risk factors or preconception counselling was analysed using χ 2 tests. Results: We enrolled 201 pregnancies in 136 women. 57.8% of pregnancies showed a high-risk profile for pre-eclampsia (history of pre-eclampsia, multifetal gestation, chronic hypertension, lupus nephritis or aPL), another 26.6% had at least one moderate risk factor (nulliparous, body mass index>30 or age>35). LDA was administered in 43.3% of pregnancies. LDA use was significantly higher in those with a high-risk profile (63.5% vs. 16.7%) [OR 8.59 (95%-CI: 4.19–18.62), p<0.001], but not in those with a moderate-risk profile. Still, 36.5% of those at high risk and 83% of those at moderate risk did not receive Aspirin. In a descending order, aPL, multifetal gestation, lupus nephritis and nulliparity were associated with a higher LDA use, whereas the other risk factors were not. Preconception counselling significantly increased Aspirin administration [OR 2.36 (95%-CI: 1.23–4.63), p<0.01], especially in those at high risk [OR 4.12 (95%-CI 1.72–10.16), p<0.001]. Overall, LDA use increased from 1995 to 2019 (χ 2 test for trend in proportions, p<0.001). Conclusions: We found a high prevalence of pre-eclampsia risk factors and infrequent use of aspirin in pregnant SLE patients. Preconception counselling increases the LDA use and thereby can improve pregnancy outcomes.