Updates on lupus and pregnancy.
This review focuses on events subsequent to planning a pregnancy and addresses three components of concern for women with systemic lupus erythematosus: maternal, placental, and fetal. Flare rates are generally low for patients who are clinically stable at conception. For patients who have never had renal disease, there is no frm evidence that they will develop active renal disease simply due to being pregnant. For patients who begin pregnancy with an abnormal creatinine (> 2 mg/dl is ill advised), risks include hypertension, preeclampsia, high rate of fetal loss, and possible further deterioration of renal function. Discontinuation of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and mycophenalate is mandatory. Elevated levels of sVEGF-1 may be a harbinger of preeclampsia. For patients with anti-phospholipid antibodies detected in the frst trimester of pregnancy, the lupus anticoagulant per se may be the strongest predictor of pregnancy complications. For women with anti-SSA/Ro antibodies the risk of having a child with congenital heart block is 2% which rises to a recurrence rate of 18%. Information on current approaches to prevention and treatment of heart complications of neonatal lupus is provided.
Buyon
Jill P
JP
Division of Rheumatology, Department of Medicine, NYU Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York 10019, USA. jill.buyon@nyumc.org
D000974:Antibodies, Antinuclear / Q000097:blood; D002317:Cardiovascular Agents / Q000009:adverse effects; D005260:Female; D005333:Fetus / Q000276:immunology; D006305:Health Status Indicators; D006330:Heart Defects, Congenital / Q000276:immunology; D006801:Humans; D007674:Kidney Diseases / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000276:immunology* / Q000517:prevention & control; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids / Q000009:adverse effects
D000974:Antibodies, Antinuclear; D002317:Cardiovascular Agents; C035356:SS-A antibodies; D013256:Steroids