Sweden: Women with systemic lupus erythematosus (SLE) are at twice the risk for gestational diabetes during pregnancy versus those without SLE, reveals a recent study in The Journal of Rheumatology.
The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide, partly due to older maternal age at pregnancy and higher obesity and diabetes prevalence. Insulin resistance is an important risk factor for gestational diabetes and is more common in women with SLE compared to the general population. However, there is no clarity on whether women with SLE are at a higher GDM risk than women from the general population.

Against the above background, Sofie A.M. Gernaat, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden, and colleagues aimed to investigate GDM risk associated with SLE by comparing pregnancies in women with SLE to general population controls.
For this purpose, the researchers identified singleton pregnancies among women with SLE and general population controls in the Swedish Medical Birth Register (MBR; 2006–2016), sampled from the population-based Swedish Lupus Linkage (SLINK) cohort (1987–2012). Risk ratios (RRs) of GDM associated with SLE were estimated using modified Poisson regression models.
GDM was defined by ≥ 1 ICD-coded visit in the NPR or MBR. SLE was defined by ≥ 2 International Classification of Diseases (ICD)-coded visits in the National Patient Register (NPR) and MBR, with ≥ 1 visit before pregnancy. The identification of glucocorticoid (GC) and hydroxychloroquine (HCQ) dispensations was done within 6 months before and during pregnancy in the Prescribed Drug Register.
Based on the study, the researchers found the following:
695 SLE pregnancies including 18 (2.6%) with GDM and 4644 non-SLE pregnancies including 65 (1.4%) with GDM were identified.
Adjusted RRs of GDM associated with SLE were 1.11 for first deliveries and 2.03 for all deliveries.
Among SLE pregnancies, GDM occurred in 7/306 (2.3%) with ≥ 1 GC before and/or during pregnancy, 11/389 (2.8%) without GC, 7/287 (2.4%) with ≥ 1 HCQ before and/or during pregnancy, and in 11/408 (2.7%) without HCQ.
"SLE was associated with a 2-fold higher risk of GDM when looking at all deliveries," wrote the authors. "GDM occurrence did not differ by GC or HCQ."
Reference:
Gestational Diabetes Mellitus Risk in Pregnant Women With Systemic Lupus Erythematosus Sofie A.M. Gernaat, Julia F. Simard, Anna-Karin Wikström, Elisabet Svenungsson, Elizabeth V. Arkema The Journal of Rheumatology Dec 2021, jrheum.210087; DOI: 10.3899/jrheum.210087
KEYWORDS: systemic lupus erythematosus, gestational diabetes, pregnancy, SLE, Sofie AM Gernaat, Journal of Rheumatology, glucocorticoid, hydroxychloroquine, insulin resistance, GDM, delivery, lupus, inflammatory disease