lupus erythematosus in pregnancy
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Clinical manifestations
- normal fertility rates
- babies are generally small for gestational age, but healthy
- neonatal lupus is rare
- poor fetal outcomes occur in women who develop clinically apparent SLE years after pregnancy[2]
Laboratory
- anti-phospholipid antibodies place fetus at increased risk
- anti-SSA Ab (anti-Ro Ab) in high titer associated with neonatal heart block[1]
Diagnostic procedures
- if anti-Ro Ab, obtain fetal cardiac ultrasound to assess neonatal heart block[1]
Complications
- miscarriage 1.5-3 fold increase
- effects of pregnancy on incidence of lupus flares is controversial
- active maternal lupus places fetus at increased risk
- SLE disease activity increases risk of preeclampsia[1]
- pre-eclampsia in pregnant women with SLE may be difficult to distinguish from lupus nephritis[1]
- antiphospholipid antibodies in pregnant women with SLE
- predispose to venous thromboembolism both
- intra-partum
- post-partum
- associated with 2nd & 3rd trimester fetal loss[1]
- predispose to venous thromboembolism both
- neonatal lupus effects 1-2% of children with mothers having anti-SSA or anti-SSB, regardless if mother has SLE or Sjogren's syndrome[1]
- lupus nephritis is common in women with active SLE during pregnancy[9]
Management
- a rheumatologist & an obsetrician with experience in high-risk pregnancy should monitor women within 6 months of conception through the puerperium[1]
- pregnancy recommended only for women taking < 10 mg/day of prednisone
- patients whose disease has been quiescent for 6 months prior to pregnancy & who are not taking medications or who are taking medications that may be continued during pregnancy, generally have favorable outcomes
- permitted medications during pregnancy include prednisone. hydroxychloroquine & azathioprine
- hydroxychloroquine is safe during pregnancy despite pregnancy category 3 rating[1]
- women with antiphospholipid antibodies & a history of miscarriage may be treated with low-dose aspirin & LMW heparin
- fetal heart block may be treated with fetal cardiac pacing[7]
- fetal heart block detected by fetal cardiac ultrasound
More general terms
Additional terms
References
- ↑ Jump up to: 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015.
- ↑ Jump up to: 2.0 2.1 Dhar JP, Essenmacher LM, Ager JW, Sokol RJ. Pregnancy outcomes before and after a diagnosis of systemic lupus erythematosus. Am J Obstet Gynecol. 2005 Oct;193(4):1444-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16202739
- ↑ Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MA. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis. 2010 Jan;69(1):20-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19103632
- ↑ Clowse ME, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008 Aug;199(2):127.e1-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18456233
- ↑ Lateef A, Petri M. Management of pregnancy in systemic lupus erythematosus. Nat Rev Rheumatol. 2012 Dec;8(12):710-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22907290
- ↑ Izmirly PM, Costedoat-Chalumeau N, Pisoni CN et al Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation. 2012 Jul 3;126(1):76-82 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22626746
- ↑ Jump up to: 7.0 7.1 NEJM Knowledge+ Rheumatology
- ↑ Clowse MEB, Eudy AM, Kiernan E et al The prevention, screening and treatment of congenital heart block from neonatal lupus: a survey of provider practices. Rheumatology (Oxford). 2018 Jul 1;57(suppl_5):v9-v17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30137589 PMCID: PMC6099126 Free PMC article PMID: https://www.ncbi.nlm.nih.gov/pubmed/19493059
- ↑ Jump up to: 9.0 9.1 NEJM Knowledge+ Nephrology/Urology