By: 29 May 2020
Women four times more likely to develop Lupus after stillbirth

Women who have gone through the trauma of having a stillbirth are four times more likely to develop Lupus than women with an uncomplicated live birth, according to a University of Manchester study.

The researchers also found a link between stillbirth and connective tissue disorders, though Lupus had by far the strongest association.

They also showed that the first signs of Lupus—the presence of antibodies—could appear up to five years after stillbirth without symptoms. And that suggests many women may get pregnant without realising the risks, or lose their baby without knowing why.

The team studied more than 100,000 mothers to see if those who had lost babies went on to develop lupus, connective tissue disease, or anti-phospholipid syndrome or antibodies.

They used the Clinical Practice Research Datalink, a world-renowned system that collects anonymised patient data from a network of GP practices across the UK.

They performed statistical regression to calculate the relative risk ratios, and compared stillbirth with live births.

The study was published in the British Journal of Obstetrics and Gynaecology and funded by the charities Tommy’s and Sparks through its Lupus In Pregnancy Study (LIPS) partnership.

Dr Hannah Kither, a researcher at the University of Manchester and Obstetrician at Royal Bolton NHS Trust, was the study’s lead author.

She said: “Stillbirth leaves both a psychological and a biological legacy; this study shows quite conclusively that these women have an increased risk of developing Lupus.”

“We think that either the stillbirth is a result of underlying immunological abnormalities akin to that seen in Lupus or that the stillbirth itself triggers a cascade of immune reactions in the maternal system culminating in CTD in later life.”

“The impact of stillbirth is traumatic—and the worries over having complications later on will be doubly hard for these women.”

“But we hope the knowledge this research gives them will empower them in future years.”

Professor Alex Heazell, a researcher at the University of Manchester and Consultant Obstetrician and Director of the Tommy’s Stillbirth Research Centre at Saint Mary’s Hospital, part of Manchester University NHS Foundation Trust, was a member of the research team.

He said: “When women have a stillbirth they are screened for a range of diseases, but now we know Lupus won’t appear until much later—sometimes years later.”

“As stillbirth is now a known risk factor for Lupus, GPs should be aware of this when seeing their patients’ investigation results. Women themselves should also be vigilant and look out for symptoms of Lupus which include joint pain, muscle pain and chronic fatigue.”

“Around 1 in 240 women in the UK suffer a stillbirth, this affects a lot of women so we feel action is needed.”

Tommy’s CEO Jane Brewin commented: “This study gives a strong steer that pregnant women should be tested early on for lupus and other related diseases, so that doctors can keep a close eye on anyone at risk throughout their pregnancy and beyond.”

“We know that both lupus and baby loss are more common in BAME communities, but previous investigations of the link between these issues have come from countries that aren’t as diverse as the UK, so this study gives us a really important new insight. That said, it can’t tell us whether connective tissue disorders were the cause or the result of stillbirth—so we need more in-depth research to unpick that relationship, which is why Tommy’s set up the Manchester LIPS clinic with Sparks.”

Source: University of Manchester