Risk factors of systemic lupus erythematosus flares during pregnancy.
This review examines the risk factors for the development of systemic lupus erythematosus (SLE) flares during pregnancy. In preconception, anti-DNA, hypocomplementemia, previous thrombosis, triple antiphospholipid (aPL) antibody positivity, active lupus nephritis and discontinuation of medications such as hydroxychloroquine and azathioprine are factors associated with pregnancy failure. During pregnancy, SLE flares are associated with aPL antibodies, synergic changes of pregnancy on Th1 and TH2 cytokines, other cytokines and chemokines that interact with hormones such as estrogen and prolactin that amplify the inflammatory effect. From the clinical point of view, SLE activity at pregnancy onset, thrombocytopenia, lupus nephritis, arterial hypertension, aPL syndromes, preeclampsia is associated with lupus flares and fetal complications. In puerperium, the risk factors of flares are similar to pregnancy. Hyperactivity of immune system, autoantibodies, hyperprolactinemia, active lupus nephritis, decrease in TH2 cytokines with increase in TH1 cytokines probably participate in SLE flare. The SLE flares during pregnancy make the difference between an uncomplicated pregnancy and pregnancy with maternal and fetal complications. Therefore, the knowledge of risk factors leads the best treatment strategies to reduce flares and fetal complications in SLE patients.
Direction of Education and Research, Hospital de Especialidades, Centro Médico La Raza, Instituto Mexicano del Seguro Social, Universidad Nacional Autónoma de México, Seris/Zaachila s/n, Colonia La Raza, 02990, Mexico City, Mexico, luis_jara_quezada@hotmail.com.
Luis J
LJ
Jara
Gabriela
G
Medina
Pilar
P
Cruz-Dominguez
Carmen
C
Navarro
Olga
O
Vera-Lastra
Miguel A
MA
Saavedra
D018450:Disease Progression; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000276:immunology / Q000378:metabolism; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000276:immunology* / Q000378:metabolism; D015213:Neuroimmunomodulation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000276:immunology* / Q000378:metabolism; D012307:Risk Factors
D007155:Immunologic Factors