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Pregnancy in systemic lupus erythematosus

M A Khamashta1, G R Hughes

  • 1Lupus Research Unit, Rayne Institute, St. Thomas' Hospital, London, UK.

Current Opinion in Rheumatology
|September 1, 1996
PubMed
Summary

Systemic lupus erythematosus (SLE) can affect fertility, particularly with cyclophosphamide therapy. While SLE pregnancy carries risks like fetal loss, especially with antiphospholipid antibodies, careful management can improve outcomes.

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Area of Science:

  • Reproductive immunology
  • Maternal-fetal medicine
  • Rheumatology

Background:

  • Systemic lupus erythematosus (SLE) typically does not impair fertility.
  • Cyclophosphamide therapy in SLE patients increases the risk of amenorrhea.
  • The impact of pregnancy on SLE activity remains debated, but SLE is linked to increased pregnancy loss.

Purpose of the Study:

  • To review the implications of pregnancy in women with SLE.
  • To highlight the role of antiphospholipid antibodies in pregnancy complications.
  • To discuss management strategies for lupus pregnancy.

Main Methods:

  • Literature review on SLE and pregnancy outcomes.
  • Analysis of factors contributing to fetal loss in SLE pregnancies.
  • Discussion of diagnostic and therapeutic approaches for antiphospholipid syndrome in pregnancy.

Main Results:

  • Most excess fetal loss in SLE is associated with antiphospholipid antibodies.
  • Prematurity, intrauterine growth retardation, and preeclampsia are frequent in SLE pregnancies, particularly with antiphospholipid antibodies.
  • Antiphospholipid syndrome in pregnancy necessitates multidisciplinary expert care.

Conclusions:

  • Pregnancy in women with SLE, especially with antiphospholipid antibodies, requires specialized management.
  • Close monitoring, including Doppler scans and timely delivery, can improve fetal outcomes.
  • Specific treatments like fluorinated steroids may be beneficial for fetal conditions like congenital heart block.

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