Presentation: Obstetric Hospitalizations in Women with Systemic Sclerosis and Primary Pulmonary Hypertension (2007)

4 Obstetric Hospitalizations in Women with Systemic Sclerosis and Primary Pulmonary Hypertension

Purpose: Systemic sclerosis (SSc) and primary pulmonary hypertension (PPH) are uncommon diseases predominantly affecting women and characterized by non-inflammatory vasculopathy. Women with these diseases are often counseled against becoming pregnant for fear of adverse maternal and fetal outcomes. We sought to estimate the nationwide occurrence of pregnancies in women with SSc and PPH and to compare pregnancy outcomes to those in the general obstetric population.
Methods: We studied the Nationwide Inpatient Sample (NIS), of the Healthcare Cost and Utilization Project to estimate the number of obstetric hospitalizations among women with SSc, PPH, and the general population. The NIS is a database of all discharge records from a nationally representative sample of U.S. hospitals. ICD-9 codes were used to identify obstetric hospitalizations in patients with SSc and PPH. We combined data from 2002 through 2004 to ascertain enough cases for analysis. Sampling weights were applied to obtain population estimates. Rates of pregnancy outcomes in patients with SSc and PPH were compared to the general population. Outcomes included length of hospital stay, proportion of non-delivery hospitalizations, hypertensive disorders including preeclampsia, and cesarean delivery. We performed multivariable analyses for length of hospital stay and rate of cesarean delivery controlling for maternal age and ethnicity.
Results: Of an estimated 13.9 million obstetric hospitalizations during 2002-2004, approximately 700 (95% CI: 548-851) occurred in women with SSc and 427 (95% CI: 321-533) in PPH. Only 73% resulted in delivery among women with SSc and 44% among women with PPH compared to 80% of general obstetric hospitalizations. Women with SSc and PPH had 3- and 4- fold increased rates of hypertensive disorders compared with the general population, respectively (p<0.001). Length of hospital stay and rates of cesarean delivery were also increased for both groups compared to the general population. (Table) Even after adjustment for maternal age and ethnicity, SSc and PPH were associated with an increased odds of hypertensive disorders (OR 3.77 and 5.95 respectively, p<0.001), and an increased risk for longer length of stay (p<0.001). There were too few fetal or maternal deaths for analysis.
Conclusions: Pregnancies in women with SSc and PPH are very rare and are associated with high risks of maternal and fetal morbidity. Women with these diseases should be counseled about risks of adverse pregnancy outcomes if they are considering pregnancy. All pregnancies should be monitored closely for the development of complications.
Outcomes of Obstetric Hospitalizations
Outcomes of Obstetric Hospitalizations
Diagnosis% CaucasianAge (years)Length of Stay (Days)% Non-delivery Hospitalizatiosn% With Hypertensive Disorders% Cesarean Delivery (among deliveries)
SSc51.629.6*5.37*26.8*25.5*42.0*
PPH54.431.3*7.32*56.5*32.6*57.5*
General Population43.927.52.6319.88.131.3
* p<0.001

 E.F. Chakravarty, None; D. Khanna, None; L. Chung, None.