Update on systemic lupus erythematosus pregnancy

Iozza, Irene and Cianci, Stefano and Di Natale, Angela and Di Natale, Giovanna and Giacobbe, Anna Maria and Giorgio, Elsa and De Oronzo, Maria Antonietta and Politi, Salvatore (2010) Update on systemic lupus erythematosus pregnancy. Journal of prenatal medicine, 4 (4). pp. 67-73. ISSN 1971-3290

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Abstract

Women with Systemic Lupus Erythematosus (SLE) still face significant risks when embarking on a pregnancy. Improvements in the field of pathophysiology, in diagnosis and a greater number of therapeutic options in the treatment of SLE, have made the medical community regard these patients with less trepidation. Despite these advances, however, the risk of significant morbidity to both the mother and the fetus still exists. The interaction of lupus and pregnancy is very complex: the consensus is that pregnancy can worsen the lupus disease process, even if this is not predictable, and pregnancy can mimic the clinical manifestations of lupus, particularly preeclampsia/ eclampsia. More specifically, pregnancy is associated in 50 to 60% of cases with a clinical flare manifesting as renal or hematological symptoms. Severe flares are uncommon (10%) and the risk of maternal death is now 2 to 3%. The risk of the fetus remains high, however with increased risk of spontaneous fetal wastage and premature births, by 4.8 and 6.8 times, respectively. It is well documented that antiphospholipid syndrome and antiphospholipid antibodies are strongly associated with fetal wastage. Low-dose aspirin or heparin improves fetal outcome in these cases. Timing a pregnancy to coincide with a period of disease quiescence for at least 6 months strongly increases the chances for a healthy and uneventful pregnancy for both mother and baby. Close surveillance, with monitoring of blood pressure, proteinuria and placental blood flow by doppler studies helps the early diagnosis and treatment of complications such as pre-eclampsia and foetal distress. Women with SLE frequently need treatment throughout pregnancy based on hydroxychloroquine, lowdose steroids and azathioprine. This update, based on previous available literature, should inform rheumatologists, obstetricians and neonatologists who guide patients in their reproductive decisions.

Item Type:	Article
Uncontrolled Keywords:	Fetal loss, Lupus nephritis, antiphospholipidsyndrome, congenital heart block, anticardiolipin antibod-ies, systemic lupus erythematosus.
Subjects:	600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 618 Altri rami della medicina; Ginecologia e ostetricia, Pediatria, Geriatria > 618.3 Malattie e complicazioni della gravidanza
Depositing User:	Gianni Aiello
Date Deposited:	30 Apr 2013 12:11
Last Modified:	16 May 2013 12:28
URI:	http://eprints.bice.rm.cnr.it/id/eprint/5100

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