40 - Pregnancy and Autoimmune Disease, Reproductive and Hormonal Issues

Abstract

Systemic lupus erythematosus (SLE) preferentially affects women during the childbearing years, making issues of contraception, fertility, and pregnancy of the utmost importance to women diagnosed with this chronic disease. It is clear that female sex hormones can affect the immune system and may impact the activity and trajectory of underlying SLE. With improvements in the monitoring and management of SLE, women with the disease have less functional impairments, end-organ damage, or reduced life expectancy; therefore, they increasingly feel healthy enough to bear and raise children. Pregnancy in women with SLE can carry higher risks of adverse maternal and fetal outcomes. Increased disease activity at the time of conception is among the most impactful and modifiable risk factors for adverse pregnancy outcomes. Additionally, a small subset of medications used for SLE are known teratogens and must be avoided during pregnancy. Therefore safe and effective contraception is critical to limit pregnancies to times of relative disease quiescence and while women are not taking teratogenic medications. Many commonly used medications to treat SLE have been shown to be compatible with pregnancy and can help to control underlying disease allowing for reduced risk of preeclampsia, prematurity, and small-for-gestational-age neonates. Similarly, menopause is a time of endogenous changes in female sex steroids that can affect SLE disease activity. Attention to uncomfortable menopausal symptoms as well as bone health and risk of hormonal malignancies are important aspects of managing women with SLE throughout their life spans.