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Outcomes for pregnancy in the setting of systemic lupus erythematosus have considerably improved but the maternal and fetal risks still remain high.
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Disease flares, preeclampsia, pregnancy loss, preterm births, intrauterine growth restriction, and neonatal lupus syndromes (especially heart block) remain the main complications.
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Specific monitoring and treatment protocols need to be used for situations such as presence of specific antibodies (antiphospholipid antibodies and anti-Ro/La).
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Safe and
Systemic Lupus Erythematosus and Pregnancy
Section snippets
Key points
Effects of pregnancy on systemic lupus erythematosus disease activity
Although opinions differ, most studies have shown that risk of SLE flare is higher during pregnancy. Variable flare rates of between 25% to 65% have been reported, likely attributable to different study designs, patient populations, and assessment tools being used.6, 7, 8 Multiple predictors for flares have been identified, including disease activity at the time of conception, lupus nephritis, and discontinuation of medications such as hydroxychloroquine (HCQ).9, 10 Most of these flares are
Effect of systemic lupus erythematosus on pregnancy outcomes
The interaction of SLE, an immune-mediated disease, and immunologic adaptations of pregnancy lead to unique challenges in this setting. Both mother and baby are at high risk of adverse pregnancy outcomes (APOs), including preeclampsia, preterm delivery, pregnancy loss, and intrauterine growth restriction (IUGR). The predictors of APO include active maternal disease, nephritis, proteinuria, hypertension, thrombocytopenia, and presence of antiphospholipid antibodies (aPLs), especially lupus
Management guidelines for pregnancy in systemic lupus erythematosus
Ideally, pregnancy should be timed during a period of disease quiescence because active disease at the time of conception is known to be one of the strongest predictors of APO. However, unplanned pregnancies are common, highlighting the often neglected need for contraceptive counseling in this group of women.42 Effective contraceptive choices include combined oral contraceptives in women with stable disease and negative aPL, progesterone-only contraceptives, and intrauterine devices, whereas
Summary
Pregnancy in women with SLE remains a high-risk condition despite considerable improvement in outcomes. Disease flares may occur during the pregnancy, and recognition and effective treatment are difficult but a realistic goal. High maternal and fetal mortality and morbidity are related to higher incidence of complications such as preeclampsia, pregnancy loss, preterm births, IUGR, and NLS, including CHB. Close monitoring, a tailored approach according to the specific risks involved, and
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Disclosures: The authors have no commercial or financial conflict of interest and no funding source for this work.