Severe Maternal Morbidity During and After Pregnancy Among Veterans With Systemic Lupus Erythematosus or Rheumatoid Arthritis.

Objective: To describe severe maternal morbidity (SMM) among veterans with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) who use Department of Veterans Affairs (VA) health care.

Methods: We conducted a secondary analysis of VA national administrative data to compare rates of SMM among veterans with and without SLE or RA. Our sample included veterans aged 18 to 45 years who had at least one pregnancy between October 2009 and September 2019 and at least one documented VA primary care visit within the year before pregnancy. International Classification of Diseases, Ninth and Tenth Revision codes were used to identify SLE, RA, and medical and mental health comorbidities within two years before pregnancy. SMM was assessed using Centers for Disease Control and Prevention definitions and included events during and up to 42 days after pregnancy.

Results: Among 29,713 veterans, 113 had SLE, and 92 had RA. Of these veterans, 36% with SLE and 30.4% with RA experienced a nonlive birth outcome, including stillbirth, ectopic pregnancy, and spontaneous abortion, compared with 25.2% of other veterans. Nearly 10% of veterans with SLE and 4.3% of veterans with RA experienced SMM, compared with 3.2% of other veterans.

Conclusion: To our knowledge, this is the first study of SMM among veterans with SLE and RA. Veterans with SLE appear to have an elevated risk of SMM, and veterans with SLE and RA appear to have high rates of pregnancy loss. Our findings highlight the potential utility of comprehensive maternity care models for these veterans with SLE and RA within the VA health care system.