Lupus Erythematosus In Pregnancy Research Articles

Management of systemic lupus erythematosus in pregnancy

Systemic lupus erythematosus is one of the most common autoimmune disorders affecting young women. Pregnant women with lupus are generally at higher risk for certain pregnancy complications than women without comorbidities. Even so, a pregnancy with lupus can be carried to term in optimal conditions if it is properly managed by a doctor. Monitoring is generally recommended six months after the onset of lupus symptoms, and ideally there should be no active lupus symptoms prior to conception. General screening tests should include the anti-phospholipid, anti-Ro and anti-La antibodies. Women who are positive for these antibodies have an increased risk of congenital heart block in the fetus. In addition, pregnant women with lupus have an increased risk of spontaneous abortion, intrauterine fetal growth restriction, pre-term birth, while neonatal lupus syndrome is a major fetal condition. The maternal risks are faced with disease flares, pre-eclampsia and other complications. Treatment options during pregnancy are limited to a few safe medications. For example, prednisone is unlikely to cause fetal malformations, but it increases the risk of diabetes and high blood pressure in the mother. Consequently, a careful multidisciplinary monitoring is essential for optimal results in pregnancy with lupus.

A case report: extremely severe pulmonary artery hypertension as an initial presentation of systemic lupus erythematosus in pregnancy

A 33-year-old G2 P1001 female at 13 weeks of gestation presented with dyspnea, tachycardia, and hypotension. Initial assessment revealed cardiogenic shock and acute respiratory failure caused by extremely severe pulmonary artery hypertension (PAH). Multidisciplinary efforts led to the diagnosis of severe PAH as an initial manifestation of systemic lupus erythematosus (SLE). Team care included gestational termination via dilation and curettage (D&C), followed by corticosteroids and vasodilator therapy, with excellent clinical and hemodynamic outcomes.

Characteristics of childhood-onset systemic lupus erythematosus in pregnancy and its association with pregnancy outcomes: a retrospective comparative cohort study

BackgroundDisease situations are more aggressive in patients with childhood-onset systemic lupus erythematosus (cSLE) than in those with adult-onset SLE (aSLE). However, information on pregnant women with cSLE and its association with pregnancy outcomes is limited. This study aimed to compare pregnancies in patients with cSLE vs. aSLE, and further analyse the characteristics of cSLE in pregnant women and explore its association with adverse pregnancy outcomes.MethodsAltogether, data of 167 pregnancies from 150 women, including 22 pregnancies with cSLE and 145 pregnancies with aSLE, were retrospectively analysed. Characteristics and disease activity were compared between the cSLE and aSLE groups during pregnancy. Associations between cSLE and the risk of active SLE (SLEPDAI > 4), active lupus nephritis (LN), and adverse pregnancy outcomes were analysed using logistic regression.ResultsThe cSLE group had a higher incidence of active SLE (12/22 vs. 30/145, P = 0.001) and active LN (11/22 vs. 26/145, P = 0.001) than the aSLE group. In the multivariable analysis, cSLE was a risk factor for active SLE and active LN during pregnancy, with ORs of 4.742 (95%CI 1.678–13.405, P = 0.003) and 4.652 (95%CI 1.630–13.279, P = 0.004), respectively. No significant association between cSLE and the risk of composite adverse gestational outcomes was identified after sequentially adjusting pre-pregnancy characteristics and pregnancy factors (P > 0.05).ConclusionDisease activity of women with cSLE in pregnancy was more aggressive than that of women with aSLE, which was similar to the characteristics of non-pregnant women with SLE. cSLE might have indirect effects on the risk of adverse pregnancy outcomes through LN and active disease. Therefore, closely monitoring patients with cSLE during pregnancy is crucial.

Competence of medical and obstetric registrars in the management of systemic lupus erythematosus in pregnancy.

Systemic lupus erythematosus has a predilection for women of childbearing age. Globally a shortage of rheumatologists exists resulting in general physicians and obstetricians treating systemic lupus erythematosus in pregnancy. We conducted a survey amongst medical and obstetric registrars in South Africa to assess their subjective and objective competence in managing pregnant women with systemic lupus erythematosus. The pass rate for the objective section was 70.8% with no statistically significant difference in the pass rate between medical and obstetric registrars. Participants felt unprepared to manage pregnant women with systemic lupus erythematosus, with a mean overall score of 3.4 out of 7 for the subjective section, based on four Likert scale type questions. Trainees are not able to accurately assess their own levels of competence in order to identify their learning needs. Due to the shortage of rheumatologists and lack of obstetric physicians in South Africa, general physicians and obstetricians must be equipped to provide adequate care to pregnant women with systemic lupus erythematosus.

Systemic lupus erythematosus in pregnancy: high risk, high reward.

The aim of this study was to describe risks of systemic lupus erythematosus (SLE) in pregnancy and the importance of preconception counselling, medication optimization and close surveillance. Advances in care for pregnant patients with SLE have led to improved obstetric outcomes, but maternal and foetal risks continue to be elevated. Conception during periods of disease quiescence and continuation of most medications decrease adverse pregnancy outcomes. Hydroxychloroquine (HCQ) appears protective against flares in pregnancy, neonatal congenital heart block and preterm birth. SLE in pregnancy confers increased maternal and foetal risks, including disease flares, preeclampsia, preterm birth, foetal growth restriction, neonatal lupus erythematosus (NLE) and congenital heart block. Disease control on an effective medication regimen mitigates many of these risks, but pregnancy in women with SLE remains a high-risk condition requiring multidisciplinary care and an individualized approach to each patient.

Management of Systemic Lupus Erythematosus in Pregnancy

Management of Systemic Lupus Erythematosus in Pregnancy

Management of Systemic Lupus Erythematosus in Pregnancy

Management of Systemic Lupus Erythematosus in Pregnancy

Treatment of corticosteroid-refractory new onset systemic lupus erythematosus in pregnancy with plasmapheresis and immunoadsorption

Treatment of corticosteroid-refractory new onset systemic lupus erythematosus in pregnancy with plasmapheresis and immunoadsorption

Systemic lupus erythematosus

Systemic lupus erythematosus in pregnancy brings risks for the mother, and possible harm to the fetus if the disease is treated. This article discusses the challenges of management

Management of Thrombosis in Antiphospholipid Syndrome and Systemic Lupus Erythematosus in Pregnancy

Pregnancy is a high risk period for thrombosis in women with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) with antiphospholipid antibodies (aPL). Thrombosis may affect the mother, both in the venous and arterial beds, and also have a role in pregnancy loss. Thromboprophylaxis thus is warranted in most of these women. However, specific regimens containing low-dose aspirin, unfractionated heparin (UH), low molecular weight heparin (LMWH), and even dicumarinics in some circumstances after the first trimester are still a matter of controversy. Women with previous thrombosis should receive full antithrombotic doses of UH or LMWH during the whole pregnancy. Treatment of pregnancy losses is more debated, consisting of low-dose aspirin with or without associated heparin. The choice of treatment for a given patient must always take into account the woman's opinion after a careful discussion with the treating physician. Peripartum thromboprophylaxis with LMWH in women receiving aspirin-only regimens and prevention of osteoporosis in those treated with heparin are considered essential in the medical management of these patients.

Lymphocyte responses in systemic lupus erythematosus in pregnancy

There is a high incidence of pregnancy loss in patients with systemic lupus erythematosus (SLE). This may be due to clinically undetectable exacerbations of the disease. Two case reports are presented in which the patients' lymphocyte responses were assessed throughout pregnancy. The results obtained suggest that monitoring lymphocyte responses may be a useful indicator of disease activity in pregnancy.

Systemic lupus erythematosus in pregnancy in Hong Kong Chinese.

AbstractIn 37 pregnancies, 28 patients with systemic lupus erythematosus managed in the Department of Obstetrics and Gynaecology of University of Hong Kong in 1973–1982 were reviewed. The abortion rate was much lower than expected. There was no perinatal loss in the series. Renal involvement does not give a worse prognosis, but active disease during pregnancy is associated with a significantly lower birth weight than the inactive disease.

Systemic Lupus Erythematosus in Pregnancy Treated with Azathioprine

Systemic Lupus Erythematosus in Pregnancy Treated with Azathioprine

Systemic lupus erythematosus in pregnancy with haemolytic anaemia, leucopenia and thrombocytopenia in the mother and her newborn infant.

Systemic lupus erythematosus in pregnancy with haemolytic anaemia, leucopenia and thrombocytopenia in the mother and her newborn infant.