Rashmi Dhital, MD

University of California, San Diego
Project Title: Health Disparities in Pregnancy Outcomes in Patients with Systemic Lupus Erythematosus (SLE)
Mentor(s): Kenneth Kalunian, MD and Christina Chambers, PhD, MPH

About the Researcher

Rashmi Dhital, MD, is currently in her second year of rheumatology fellowship at the University of California San Diego. She completed her medical school training in Nepal and internal medicine residency at the Reading Hospital in Pennsylvania. During her residency, she developed an interest in clinical research and was fortunate to receive guidance from strong mentors who taught her the tools and concepts required to conduct scholarly projects. Dr. Dhital’s interest in rheumatology stemmed from her experience caring for a young woman with lupus during her residency and witnessing the challenges she endured as a result of her disease. It was only during their rheumatology fellowship that Dr. Dhital had the opportunity to care for many young patients with rheumatic diseases, which gave her a deeper understanding of the complex reproductive health challenges they face, particularly those with lupus. This sparked her interest in learning about the needs and challenges in this area and prompted her to focus her research towards narrowing the knowledge gap and improving the quality of reproductive health care for patients with rheumatic diseases.

During residency and fellowship, Dr. Dhital gained experience in utilizing national databases such as the National Inpatient Sample, National Emergency Department Sample, and National Readmission Database to investigate hospitalization trends, sociodemographic predictors, and disease outcomes. The findings of her research have been published in peer-reviewed journals and presented at national meetings, including the American College of Rheumatology (ACR) annual meetings. She was awarded the prestigious Marshall J Schiff MD Memorial Fellow Research Award for presenting her team's research on "Epidemiology and Outcomes of Emergency Department Visits in Systemic Lupus Erythematosus (SLE): Data from National Emergency Database Sample" at the ACR 2022 meeting. She was also selected to receive the “Emerging Investigator Excellence Award” for the Reproductive Issues in Rheumatic Disorders category for her abstract titled “Acute Cardiovascular Events in Autoimmune Rheumatic Disease Pregnancies” which was accepted for presentation at the plenary session at the ACR 2023 meeting. 

Dr. Dhital’s primary interest is to learn how to utilize databases and patient registries, and to design and perform longitudinal studies using primary data sources like electronic health records. To pursue her research interests, she attended courses including the VERITY/Brigham Course in Rheumatology Clinical Research, and is also currently enrolled in Clinical Research Enhancement through Supplemental Training (CREST) course at UC San Diego. She is also pursuing a training experience with the MotherToBaby team, under the mentorship of Dr. Christina Chambers, working on utilizing two pregnancy databases, the Study of Outcomes in Mothers and Infants (SOMI), and Organization of Teratology Information Specialists (OTIS) to explore different aspects of reproductive rheumatology

Dr. Dhital’s main focus in research is on lupus and reproductive rheumatology. Her immediate goal is to enhance her ability to effectively utilize large databases containing longitudinal data on patient and disease characteristics and outcomes to conduct patient-centered research. And, her long-term goal is to identify modifiable clinical and epidemiological factors that can improve reproductive health outcomes for young women with rheumatic diseases. With the proposed project, Dr. Dhital will be able to work closely with her mentors to improve her research skills and answer important questions relating to the care of pregnant women with lupus. Her ultimate goal is to become a faculty member at an academic institution with a strong emphasis on patient care and clinical research. She aspires to collaborate with experienced investigators, conduct independent clinical research, and make meaningful contributions to advancing this field.

Project Summary

Pregnant women with lupus are at a higher risk of experiencing complications during pregnancy that can affect the health of the mother or the baby. Our analysis of a large California pregnancy database from 2005 to 2020 showed that lupus patients have a much higher risk of heart/blood vessel problems during pregnancy than women without lupus, highlighting that there are differences in the health outcomes for pregnant women with and without lupus. In this proposed study, we want to study if pregnant women with lupus who have heart/blood vessel problems are more likely to have undesirable complications during pregnancy, and if race plays a role in this.

In the first part of the study, we will compare the risks of pregnancy complications such as preterm births, death of a baby before or during delivery, and small babies in women with lupus who experienced heart/blood vessel problems during pregnancy, to those without lupus who experienced similar issues, and to women with lupus who did not experience such heart/blood issues. To do this, we will use the same California pregnancy database from 2005 to 2020 to compare the outcomes in 8,422 pregnant women with lupus to 7,004,334 pregnant women without lupus. In the second part of the study, we will investigate how often heart/blood vessel problems occur in lupus patients of different races and whether they affect pregnancy outcomes differently depending on the race of the pregnant woman.

This study aims to improve our understanding of the health discrepancies faced by pregnant women with lupus, especially those of non-White races. If the study finds that heart/blood vessel problems are more prevalent in certain groups of pregnant lupus patients and affect pregnancy outcomes differently, future studies could help understand the reasons for these differences, such as disparities in healthcare access. These findings could help us identify measures that can reduce such risks and improve pregnancy outcomes for lupus patients.