Systemic lupus erythematosus and pregnancy.
OBJECTIVE
Pregnancy in patients with systemic lupus erythematosus is associated with a high risk of maternal disease exacerbation and adverse fetal outcome. This review summarizes recent published findings on lupus pregnancy.


RESULTS
The literature is in agreement that for most women with inactive and stable systemic lupus erythematosus, pregnancy is safe for both mother and fetus. The main risk factors for adverse pregnancy course and outcome are active disease, nephritis with proteinuria, hypertension, and maternal serum antibodies to SS-A/Ro, SS-B/La, cardiolipin, beta2-glycoprotein I, and lupus anticoagulant. Recent studies have broadened our understanding of the immunological mechanism underlying congenital heart block induced by anti-Ro/La antibodies. In addition, the approach to oral contraceptives has been modified on the basis of two well controlled studies suggesting that they do not cause exacerbation of inactive or mild disease.


CONCLUSIONS
Pregnancy in patients with systemic lupus erythematosus is safe and manageable provided the disease is stable. Patients should be evaluated before pregnancy for pregestational risk factors and be closely followed during pregnancy. In most cases of lupus flare during pregnancy, the disease can be safely managed.
Molad
Yair
Y
Rheumatology Unit, Rabin Medical Center, Beilinson Campus, Petah Tiqwa and Internal Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ymolad@clalit.org.il
D001324:Autoantigens / Q000276:immunology; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology / Q000628:therapy; D012261:Ribonucleoproteins / Q000276:immunology; D000097585:SS-B Antigen; D000099207:SS-A Antigen
D001324:Autoantigens; D003278:Contraceptives, Oral, Hormonal; D012261:Ribonucleoproteins; D000097585:SS-B Antigen; D000099207:SS-A Antigen