Thursday, 21 Sep 2017

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Pregnancy in Lupus

Today’s session by Fischer-Betz Rebecca from Germany was very interesting. Young patients with systemic lupus erythematosus (SLE) get diagnosed before they have completed their families. About 30 or 40 years ago, most rheumatologists were not recommending pregnancy for their lupus patients. However, in recent times, outcomes have considerably improved. We should keep in mind that SLE does increase risk of pregnancy complications for both the mother and the child as compared to healthy women. For mothers, it increases risk of SLE flares, preeclampsia and overall medical complications. For the children, the complications include late and early fetal loss, growth retardation, neonatal lupus and congenital heart blocks.

Complications during pregnancy increase with these risk factors:

  • Active disease within 6 months prior to conception

  • Active lupus nephritis

  • Preexisting renal disease, especially renal damage

  • Associated antiphopholipid antibody syndrome

  • Chronic hypertension

  • Use of glucocorticoids (> 10-20 mg /day)

  • Discontinuation of hydroxychloroquine

Often even high-risk SLE patients get pregnant due to a strong desire to conceive.  Cornerstones of care of SLE patients who get pregnant are awareness of the disease and complications both by the physicians and patients. A multidisciplinary team approach should be used and importance of needed immunosuppression must be emphasized.

 

Pre-pregnancy counselling and appropriate management during early pregnancy improves pregnancy outcomes significantly.  Individual patients should be risk stratified and informed about them. All medications must be reviewed and comorbidities must be identified and treated. EULAR guidelines published in 2016 are useful.

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