Lupus Pregnancy Research Articles

Outcome of Pregnancy in Lupus

Background: Pregnancy in patients with SLE is associated with a high risk of maternal disease exacerbation in active disease state and adverse fetal outcome. Objective: To analyse maternal and fetal outcome in pregnant lupus patients as well as to identify influence of disease activity on it. Methods: This retrospective observational cross sectional study was done on 27 pregnant lupus patients in feto-maternal medicine wing of the department of Obstetrics and Gynaecology, BSMMU from April 2007 to March 2011. For statistical analysis ‘z’ test of proportion and student’s ‘t’ test was used. Results: Mean age of the patients was 26.6 years. At booking, 8 (29.63%) had active lupus while 19 (70.37%) was in remission. As complications of SLE, lupus flare was found in 11.1%, lupus nephritis in 25.9% and skin rash in 7.4%. Regarding obstetric complications, PIH was developed in 3.7% and preeclampsia in 11.1% of the patients. Average gestational age at delivery was 34.8 weeks. Birth weight was <2.5kg in 45.8% of neonates. There was IUGR in 33.3% of the cases and 25% of the neonates needed admission in neonatal ICU. There was no neonatal death and none of the 24 neonates had neonatal lupus. In this study there was no maternal mortality. Patients who were in active disease state, most (55.5%) delivered preterm, spontaneous abortion occurred in two and IUD in one of the patients. Average birth weight was lower (1.9+.47kg) in patients with active SLE than those of with remission (2.3+.68kg). Lupus flare developed in 66.6% with active disease, while in 33.3% with remission. Conclusion: Pregnancy is relatively safe with SLE in remission but considered as high risk in terms of fetal loss and spontaneous abortion. Disease activity influences pregnancy outcome.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10995 BSMMU J 2012; 5(1):18-23

PP144. Profile of lupus pregnancy in internal medecine practice

The pregnancies in systemic erythematous lupus (SLE) disease is a situation of high risk and involve both the mother and the fetus. The prematurity and the miscarriage are there more frequent, with increase risks of eclampsia, acute hypertension, HELP syndrome and of worsening renal disease. So the morbimortality is multiplied particularly when a anti-phospholipid syndrome 'APLS' is associated. The pregnancy remains however authorized when the SLE is in remission for more than 6 months with a validated treatment and successful means of monitoring. To review the clinical profile of the pregnancies at the SLE patients with or without APLS in Internal Medicine Practice. it's a retrospective study, in an internal medical centre over a period going from January, 2008 till December, 2011. The collection of the data is made from the index cards of clinical observations collecting items to interpret the data. All the patients are diagnosed referring to the criteria ACR (SLE/APLS) and all benefit from a follow-up in a obstetrics monitoring (ultrasounds to monitor growth and placental development). On a cohort of 80 SLE young patients hospitalized we brought together 20 patients answering eligibility criteria. The average age is of 26 years (21-41), SLE evolve with an average of 2.5years, the parity is estimated at 5 on average by patient. The pregnancies are programmed in only in 25% . The others cases of pregnancy remain the consequence of a not adapted contraception (50%). Lupus patients have history of renal damage (8) requiring immunosuppressive therapy (4) but renal function is preserved at all the patient's. The treatment is adapted to the clinical context and prophylactic doses of heparin and a baby aspirin are required in most situations. The cardiovascular and metabolic risk factors show an overweight (12), one dyslipemia (10), type 2 diabetes (2), and hypertension (3). The pregnancy is at the origin of a degradation of the renal function (4) with definitive chronic renal Insufficiency (1). The specific events observed are a HELLP syndrome (1), pre-eclampsia (2), fetal losses (5), ischemic strokes (4) and post-partum cardiomyopathy (1). The pregnancies require caesarians (15) with ligature of trunks (2). We deplore fetal deaths (7) in tripled (1) and in twin (1) during the period of follow-up. We note a small birth weight (7), a preterm birth (5), a foetal distress (5) at the origin of a psychomotor disorders (1) and we observed a case of a transient skin lupus (1). The frequency of the maternal and fetal complications is partially understandable by the fact that the majority of the pregnancies neither are programmed, nor authorized by the treating physician. Indeed, between the denial of the disease and the desire of pregnancy in everything taken, the patients often take the risk and put the treating physician in front of pregnancies in top risks.

Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy

Previous reports suggest that renal involvement before pregnancy or active renal disease during pregnancy may be associated with poor fetal and maternal outcomes in systemic lupus erythematosus (SLE) women. We report our experience of fetal and maternal complications in pregnant lupus women with and without previous lupus nephritis. We analyzed the clinical records of pregnant SLE patients attended in a tertiary reference center during a 5-year period. Patients were allocated into two groups according to the presence or absence of previous lupus nephritis. Women were evaluated monthly during pregnancy and at least 1 month postpartum. Maternal and fetal outcomes of pregnancy were abstracted. We included 95 pregnancies in 92 patients. Compared with pregnant women without lupus nephritis (n = 60), pregnancies with previous lupus nephritis (n = 35) were associated with a higher risk of maternal complications (88.5% vs. 43.3%, p = 0.00001), higher rate of lupus flares (54.2% vs. 25%, p = 0.004), and renal flares (45.7% vs. 6.6%, p = 0.00001), but most of which in most instances were reversible. On the other hand, fetal outcome was similar in both groups. Multivariate analysis showed that previous lupus nephritis and active lupus at conception were predictors of adverse maternal outcome. Pregnancies in women with previous lupus nephritis had a higher rate of maternal complications in comparison with those without. However, fetal prognosis was similar in both groups.

Prevention of anti-SSA/Ro and anti-SSB/La antibodies-mediated congenital heart block in pregnant woman with systemic lupus erythematosus: A case report

Women with connective tissue diseases increase risks of obstetric complications during pregnancy. Especially, women who have anti-SSA/Ro and anti-SSB/La auto-antibodies increase the risk of developing fetal atrioventricular (AV) block. It is difficult to indentify fetal AV block in the early stage of the disease, which is consequently found after the establishment of complete AV block as the form of fetal arrhythmia. To have a chance to reverse this serious disorder, we should detect fetal AV block in the early stage before it progresses to complete AV block. We experienced a case of pregnant systemic lupus erythematosus woman who has antiSSA/Ro and anti-SSB/La auto-antibodies monitored by cardiac doppler sonography; We detected fetal first degree AV block and successfully treated with dexamethasone. We report systemic lupus erythematosus women who increased risks of fetal AV block with a brief review of relevant literatures.

Lupus and Pregnancy

Systemic lupus erythematosus (SLE) disproportionately affects women in their reproductive age years. Pregnancy in this systemic autoimmune disease has long been associated with poor obstetric outcomes. However, the frequency of pregnancy loss in lupus has dropped to a level commensurate with that of the general US population. The outcomes of lupus pregnancies are better if conception is delayed until the disease has been inactive for at least 6 months, and the medication regimen has been adjusted in advance. Pregnancy in lupus is prone to complications, including flares of disease activity during pregnancy or in the postpartum period, preeclampsia, miscarriage, stillbirth, intrauterine growth retardation, and preterm birth. Active lupus nephritis poses the greatest risk. The recognition of a lupus flare during pregnancy may be difficult because the signs and symptoms may mimic those of normal pregnancy. Monitoring should include baseline and monthly laboratory tests, serial ultrasonography, fetal surveillance tests, and fetal m-mode echocardiography for mothers with SS-A (Ro) or SS-B (La) antibodies. In the absence of any signs or symptoms of active SLE, affected patients require no specific treatment during pregnancy. If hydroxychloroquine was in use before conception, it should be maintained throughout pregnancy. If a woman with SLE has antiphospholipid antibodies, prophylactic treatment with aspirin and/or low-molecular weight heparin is indicated to prevent fetal loss. Lupus flares during pregnancy are generally treated with hydroxychloroquine, low-dose prednisone, pulse intravenous methylprednisolone, and azathioprine. High-dose prednisone and cyclophosphamide are reserved for severe lupus complications but are associated with significant pregnancy-related complications and poor obstetrical outcomes.

Practical management of lupus nephritis in pregnancy and the puerperium

Pregnancy represents a major challenge in the management of patients with systemic lupus erythematosus, with substantial risks to both mother and baby. Over the past 40 years there have been major improvements in outcomes. This partly relates to the discovery of the antiphospholipid syndrome, which has transformed management of lupus pregnancy, but also due to more effective drugs and better obstetric practice. Despite these advances, significant maternal and fetal morbidity may still occur in patients with lupus nephritis, and there remain ongoing challenges in order to improve outcomes further. In this article we focus on the challenges facing lupus nephritis patients considering pregnancy, and discuss how we approach practical management issues in relation to the current literature.

SLE in Pregnancy

Systemic lupus erythematosus is specially a disease of young women in their child bearing age. It has been found that SLE disease activity can repair in pregnancy even though patient is in complete remission state before the pregnancy. Besides this, pregnancy complications are higher in SLE patients. Another important issue is the use of drugs to control SLE because some of these drugs are potentially terotogenic. Fetal outcome is also a challenging issue. Therefore, multidisciplinary approach has key role in the management of Lupus pregnancy. Key words: Systemic lupus erythematosus (SLE); Lupus pregnancy; Lupus flare; Anti-phospholipid Antibody Syndrome; Neonatal Lupus Syndrome; Congenital heart block. DOI: 10.3329/bsmmuj.v3i1.5517 BSMMU J 2010; 3(1): 54-59

Systemic lupus erythematosus pregnancies: the Sarawak experience and review of lupus pregnancies in Asia

We performed a cross-sessional study of all systemic lupus erythematosus (SLE) pregnancies during a 4-year period (2006-2009) to describe the clinical features, maternal and foetal outcomes in our centre. There were 48 pregnancies in 44 women with SLE. Our patients have a mean age of 30.0 years (SD 6.36) and a mean disease duration of 40.67 months (SD 48.23). Our patients have complicated pregnancies: 32.7% have SLE flares, 17.3% have preeclampsia and 48.9% needed caesarean sections. There were 20.0% foetal losses and 17.8% preterm deliveries in our patients. SLE flares contributed to 60.0% of foetal losses in our patients. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable to developed countries in Asia. The low incidence of APS, the high usage of hydroxychloroquine and the high SLE remission rate in our patients prior to conceptions contributed to the good outcome.

Systemic lupus erythematosus and pregnancy – a challenge to the clinician

Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.

Immunoadsorption for systemic lupus erythematosus

Abstract Immunoadsorption (IAS) with various methods is used as a rescue therapy in severely ill SLE patients who are refractory to conventional therapeutic procedures. The method aims at the rapid and extensive removal of pathogenic immunocomplexes (IC) and (auto-) antibodies (Abs). Long-term observational studies suggested efficacy and have not seen an increase in the risk of infections (as were seen in other extracorporeal procedures). Unfortunately, prospective, randomized controlled trials (RCT) are lacking. Recently, biologicals aiming at TNF-blockade or B-cell depletion have been used to treat severe SLE: They are easier to apply since they do not necessitate additional (expensive) hardware or specially trained staff. While there is emerging evidence for efficacy from uncontrolled observations, no RCT could so far demonstrate benefit in SLE. Under these circumstances, IAS still has a role in treating severe SLE, when other therapies are not effective enough or are contraindicated (as in pregnancy). These data are reviewed and illustrated in the case of a pregnant lupus patient with nephrotic syndrome.

Systemic lupus erythematosus pregnancies: a case series from a tertiary, East Malaysian hospital

We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a two-year period (2006-2007) to describe the clinical features, maternal and foetal outcomes in our centre. There were 17 pregnancies in 16 women with SLE. Our patients have a mean age of 28.31 years (SD 5.24) and a mean disease duration of 38.62 months (SD 38.03). Our patients have complicated pregnancies: 35.3% have SLE flares, 21.1% have preeclampsia and 47.4% needed caesarean sections. There were 15.8% foetal losses and 12.5% preterm deliveries in our patients. All the foetal losses occurred in patients with severe SLE flares during pregnancies. Lupus pregnancies in our centre generally have a good maternal and foetal outcome comparable with developed countries. The low incidence of antiphospholipid syndrome, the high usage of hydroxychloroquine and the high SLE remission rate in our patients before conceptions are the possible factors contributing to the good outcome.

TTP, ET, and ITP Sequential Occurrence in a Single Patient: a Case Report

INTRODUCTION: Thrombotic thrombocytopenic purpura (TTP), essential thrombocythemia (ET) and idiopathic thrombocytopenic purpura (ITP) are three separate disease entities that affect the platelets. Each has a different pathophysiology clinical presentation and consequences. We present a case where TTP, ET, and ITP were diagnosed in the same patient at different times of her clinical course with the aim of drawing the attention to this undocumented occurrence which remains under investigation.CASE REPORT: A 42 year old African American female was diagnosed in 1994 with TTP after she presented with slurring of speech and left upper extremity weakness. Her hemoglobin was 9.7 g/dL, creatinine of 1.3 mg/dL, LDH of 448 IU/L and her peripheral smear showed schistocytes. She was diagnosed with TTP and was treated with plasma exchange with improvement in the platelet count. In March 2001, she presented with purple toe syndrome and a platelet count of 877,000. Bone marrow biopsy revealed panmyeloid hyperplasia, clustering of megakaryocytes, and stainable iron. She was then diagnosed to have essential thrombocythemia and was started on Anagrelide, which was later switched to Hydroxyurea. In October 2001, Hydroxurea was stopped and two weeks later, her platelet count dropped to 12,000. Investigations including a bone marrow biopsy were done which showed megakaryocytes in atypical clusters. No schisocytes were seen on peripheral smear. The patient's platelet count dropped to 7,000 and she was transfused with 12 units of platelets. Post transfusion her count was 90,000 but dropped to 25,000 in less than 12 hours. She was then started on IV immunoglobulins and steroids for a presumptive diagnosis of ITP and her platelet count subsequently improved. Subsequent outpatient evaluation was negative for ANA, C3, C4, and HIVCONCLUSION: The fact that both immune and thrombotic thrombocytopenic purpura occur with increased frequency among persons with systemic lupus erythematosus, HIV disease, or pregnancy supports the hypothesis that some pathophysiologic factors are shared. As the three conditions have different natural histories and require different treatment modalities, it is important to recognize that these diseases may be seen sequentially and here comes the importance of reviewing peripheral blood smears for evaluation of thrombocytopenia and bone marrow aspirations for diagnosis of thrombocythemia in order to reach an accurate diagnosis and tailor therapy accordingly. This case demonstrates the variability and complexity of platelet disorders. Platelets may go one way or another and can even go in opposite directions in the same person. After reviewing the literature, there are no reported cases of TTP, ET, and ITP diagnosed in the same patient. Our aim is to draw the attention to this rare case which is still under investigation.

First Experiences with the Measurement of Thrombin Generation (TGA) on the Ceveron® Alpha in the Routine Lab

Aims: Aim of the study was to show the suitability of the new coagulation analyzer Ceveron® alpha for determination of thrombin generation (TGA) in routine laboratories for discrimination of normal plasma samples from haemophilic and thrombophilic patient samples, from patients with a Lupus syndrome and patients with bleeding disorders.Methods: TGA was determined by a thrombin generation assay based on monitoring the formation of thrombin by means of a fluorigenic substrate upon activation of the coagulation cascade by tissue factor and phospholipids using 2 reagents with different phospholipid concentrations (RClow and RChigh) on Ceveron® alpha. Thrombin generation is measured with a specially adapted TGA fluorimetric module which is placed over the cuvette rotor. Readout parameters were lag time (tLag), peak thrombin (Peak), time to peak(tPeak), velocity index (VI) and area under the curve (AUC). In case of patients with Lupus Anticoagulants a ratio of peak thrombin values triggered with RClow and RChigh was formed. Four laboratory groups participated in the study. All patient samples used for thrombin generation measurement were characterized by routine parameters.Results: Group 1 analyzed samples with bleeding disorders. Peak thombin values showed the best discrimination between Hemophilia B patients (41.9, SD12.7nM), Hemophilia B patient after treatment (188.9nM) and normal controls (208.5nM, SD= 74.0). In Hemophilia A patients tLag was the best parameter to discriminate severe Hemophilia A (8.5min) from acquired hemophilia A and VWD (4.6 min, SD=2.1).Normal ranges for TGA established in group 1 (n=16) were tLag 2.7min (SD=0.8), tPeak 7.8min (SD=1.9), peak thrombin 208.5nM (SD= 74), AUC 1769.4 (SD=327.9).Group 2 analyzed samples of thrombophilic patients with pregnancy (n=30). Patient samples showed peak thrombin values (310.9nM, SD= 65.7) above normals (174.2nM, SD= 22.5). Even patients with heparin treatment had high peak thrombin values (340.5nM, SD=67.2). In heparin treated patients D-dimer values were pathologic as well.Group 3 determined thrombin generation in patients with Lupus Anticoagulants determined by dRVVT, APTT-LA, Lupus-Ceveron and anti-cardiolipin antibodies (ACA). Patients only with high ACA values showed normal peak thrombin ratios of RClow/RChigh 0.6 (SD= 0.07) whereas the ratio in patients with high lupus anticoagulants as measured in the coagulation tests was 0.98 (SD= 0.31) for high antibody titer and 0.83 (SD 0.01) for low antibody titer. Inter-assay CVs in the normal control determined by this laboratory were 2.67% for peak thrombin and 4.83% for AUC and in thrombophilic plasma 3.0% for peak thrombin and 1.41% for AUC.Group 4 determined TGA in orally anticoagulated patients. Normal range for peak thrombin established in this laboratory is 220nM (SD=52, n=12). Oral anticoagulant treatment lowered the AUC (from 1713.3nM, SD= 435.4 thrombin in samples with INR in the range 1 – 1.5 to 894.4nM, SD= 229.2 thrombin in samples with INR in the range 2 – 2.5) and peak thrombin formation (from 204.1nM, SD= 73.5 peak thrombin in samples with INR in the range 1 –1.5 to 79.0nM, SD= 35.2 peak thrombin in samples with INR in the range 2 – 2.5) and prolonged the tLag (from 5.5min, SD= 1.7 in samples with INR in the range 1 –1.5 to 7.6min, SD= 2.4 in samples with INR in the range 2 – 2.5.Conclusions: TGA can be measured reproducibly with low variation under routine laboratory conditions. Peak thrombin is the best parameter for discrimination of patient samples from normals in haemophiliacs, in thrombophilia, patients with a Lupus syndrome, pregnancy and bleeding disorders. With automated, standardised thrombin generation measurement on the Ceveron® alpha large prospective studies can be conducted to confirm these results.

Lupus nephritis and pregnancy in the 21st century

Lupus nephritis and pregnancy in the 21st century

Challenges of lupus pregnancies

SLE primarily affects young females of childbearing age and fertility is generally conserved. SLE is a predominantly Th2-mediated disease and a progressive Th1/Th2 cytokine shift is seen in the fetal-maternal unit as well as in maternal circulation. Whether this fact affects pregnancy is unknown. Pregnancy represents a challenge for lupus patients and their physicians. However, the majority of SLE patients can now have successful pregnancies and deliver healthy babies, a result of our knowledge of the risks that SLE patients have to face during pregnancy, the preventive and therapeutic measures that we adopt, when necessary, and the close and appropriate rheumatological, obstetric and neonatal monitoring. All of these aspects are discussed in this review.

Bromocriptine during Pregnancy in Systemic Lupus Erythematosus

Bromocriptine (BRC) prevents postpartum flare in lupus patients. However, its potential role in protecting lupus pregnancy from maternal-fetal complications has not been studied. The objective of the study was to explore the role of oral BRC during pregnancy in patients with systemic lupus erythematosus (SLE). Pregnant SLE patients were randomized into two groups: group 1 received BRC 2.5 mg/day and prednisone 10 mg/day; group 2 received prednisone 10 mg/day. These treatments were administered from 25 to 35 weeks of gestation. Prolactin (PRL) levels were determined at 25, 30, and 35 weeks. The SLE Pregnancy Disease Activity Index, maternal-fetal outcome including preterm birth, fetal loss, premature rupture of membrane (PRM), low birth weight, and preeclampsia/eclampsia were evaluated. We studied 20 patients (10 in each group). A significant decrease of PRL levels in group 1 compared to group 2 at week 30 and at week 35 was found. No patients in the BRC group had flares and three from group 2 had SLE activity. None of the patients in group 1 had PRM but three patients in group 2 did. Eighty percent of pregnancies ended in birth at term in group 1 and 50% in group 2. There was no fetal loss in both groups. Mean birth weight was higher in group 1 than in group 2 (P < NS). BRC was well tolerated. This is the first clinical trial of BRC in SLE pregnancy. Our pilot study suggests that BRC may play a role in the prevention of maternal-fetal complications, such as PRM, preterm birth, and active disease.

Nocardia Sepsis in a Multigravida with Systemic Lupus Erythematosus and Autoimmune Hepatitis

This report describes a pregnant woman with systemic lupus erythematosus and autoimmune hepatitis who presented with threatened labour and acute renal failure. She developed respiratory distress, haematemesis and became coagulopathic. Intrauterine death occurred and she was admitted to the intensive care unit after caesarean section. She suffered sudden cardiovascular collapse and succumbed. At autopsy, Nocardia was cultured from multiple renal abscesses. The co-existence of Nocardia sepsis, systemic lupus erythematosus, autoimmune hepatitis and pregnancy are discussed. This case illustrates diagnostic challenges associated with Nocardia infection in the presence of co-existing disease.

Anti-prolactin autoantibodies in pregnant women with systemic lupus erythematosus: maternal and fetal outcome

The aim of this study was to determine in pregnant women with systemic lupus erythematosus (SLE) the frequency of anti-prolactin autoantibodies and to compare the outcome of pregnancy in SLE women with and without anti-prolactin autoantibodies. Ninety-nine consecutive SLE pregnant women and 151 healthy pregnant women were studied prospectively. Patients with or without anti-prolactin autoantibodies were identified by gel filtration chromatography and affinity chromatography for IgG. Serum total and free prolactin (PRL) levels and molecular heterogeneity of PRL at each trimester of pregnancy were determined. The frequency of anti-PRL autoantibodies in SLE pregnant women was 13.1%. Serum total PRL levels were significantly higher in women with anti-PRL autoantibodies compared with SLE women without anti-PRL autoantibodies and in healthy pregnant women; and serum free PRL levels were lower in the third trimester in women with anti-PRL autoantibodies than in healthy pregnant women. In contrast, serum total and free PRL levels were significantly lower in the second and third trimester in SLE pregnant women without anti-PRL autoantibodies compared with healthy pregnant women. All adverse outcomes of pregnancy studied were more frequent in SLE women without anti-PRL autoantibodies than anti-PRL autoantibody-positive SLE women. Moreover, both maternal and fetal main complications were significantly higher in SLE women without anti-PRL autoantibodies than anti-PRL autoantibody-positive SLE women (P </=0.03). We conclude that the frequency of anti-PRL autoantibodies in lupus pregnancy was 13.1%. SLE pregnant women with anti-PRL autoantibodies had fewer adverse outcomes of pregnancy. The presence of anti-PRL autoantibodies could be of potential use as a prognostic marker for outcomes of pregnancy in SLE.

Systemic lupus erythematosus and pregnancy: clinical evolution, maternal and perinatal outcomes and placental findings.

Systemic lupus erythematosus is a chronic disease that is more frequent in women of reproductive age. The relationship between lupus and pregnancy is problematic: maternal and fetal outcomes are worse than in the general population, and the management of flare-ups is difficult during this period. The aim here was to compare the outcomes of 76 pregnancies in 67 women with lupus, according to the occurrence or absence of flare-ups. An observational cohort clinical study evaluating the evolution of pregnant women with lupus who were receiving care at the prenatal outpatient clinic, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas (CAISM/Unicamp), between 1995 and 2002. Data were collected on a precoded form. The women were divided into two groups according to the occurrence or absence of flare-ups, as defined by the systemic lupus erythematosus disease activity index (SLEDAI). The presence or absence of flare-ups and renal involvement was considered to be the independent variable and the other results were dependent variables. Flare-ups occurred in 85.3% of cases, and were most significant when there was renal involvement. This was related to greater numbers of women with preeclampsia and poor perinatal outcome. Intrauterine growth restriction was more common in the women with active disease. Placental weight was significantly lower in the women with renal involvement. Flare-ups and renal involvement in lupus patients during pregnancy are associated with increased maternal and perinatal complications.

Lupus and Pregnancy: Complex Yet Manageable

Systemic lupus erythematosus is a chronic multi-system autoimmune disease that occurs predominantly in women of childbearing age. The risk of complications and adverse fetal outcomes in pregnant women with lupus is high. Moreover, pregnancy can cause flares of lupus disease activity necessitating maternal immunosuppressive intervention. Interestingly, many potential complications of pregnancy present as symptoms of lupus making diagnosis and treatment a challenge. Advancing technology and better understanding of the maternal-fetal dyad in lupus have improved outcomes in lupus pregnancies over the last 40 years. This article will briefly review the important issues in pregnancies complicated by lupus and provide a general guideline to physicians for monitoring and treatment.