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Pregnancy and Systemic Lupus Erythematosus
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Best Practice & Research. Clinical Obstetrics & Gynaecology
|November 4, 2019
Summary
Planning pregnancy during controlled Systemic Lupus Erythematosus (SLE) is crucial. While hydroxychloroquine is recommended, specific immunosuppressants and managing antiphospholipid syndrome with heparin and aspirin are key for successful outcomes.
Area of Science:
- Rheumatology and Immunology
- Maternal-Fetal Medicine
- Reproductive Health
Background:
- Systemic Lupus Erythematosus (SLE) often begins in young adulthood, a period when pregnancy is common.
- Pregnancy in SLE patients is considered high-risk, presenting significant maternal and fetal complications.
- Maternal risks include lupus flares, diabetes, and pre-eclampsia; fetal risks involve miscarriage, preterm birth, and congenital heart block.
Purpose of the Study:
- To outline the risks and management strategies for pregnancy in women with Systemic Lupus Erythematosus (SLE).
- To identify key medications and antibodies associated with pregnancy outcomes in SLE.
- To provide guidance for planning and managing pregnancies in the context of SLE and antiphospholipid syndrome.
Main Methods:
- Review of risks associated with SLE during pregnancy, including maternal and fetal complications.
- Identification of recommended and permissible medications for SLE management during pregnancy.
- Analysis of antiphospholipid antibodies, specifically the lupus anticoagulant, and their association with adverse pregnancy outcomes based on the PROMISSE study.
Main Results:
- Pregnancy requires careful planning during periods of well-controlled SLE and adherence to specific medication guidelines.
- Hydroxychloroquine should be continued; azathioprine and tacrolimus are the only permitted immunosuppressants.
- The lupus anticoagulant is the only antiphospholipid antibody significantly linked to adverse pregnancy outcomes in the PROMISSE study; management with low molecular weight heparin and aspirin yields a 75% success rate.
Conclusions:
- Optimal pregnancy outcomes in SLE necessitate preconception planning and management by a multidisciplinary team.
- Selective medication use (hydroxychloroquine, azathioprine, tacrolimus) and targeted management of antiphospholipid syndrome are critical.
- Continued research and monitoring are essential to improve the success rates of pregnancies in women with SLE and associated conditions.
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