title: Understanding and Managing Pregnancy in Patients with Lupus.
abstract: Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6-12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies.
authors.affiliation: Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Guilherme Ramires
authors.initials: GR
authors.lastname: de Jesus
authors.affiliation: Systemic Autoimmune Diseases Research Unit, Hospital General Regional No. 36-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico ; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mendoza-Pinto
authors.affiliation: Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Nilson Ramires
authors.initials: NR
authors.lastname: de Jesus
authors.affiliation: Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Flávia Cunha
authors.initials: FC
authors.lastname: Dos Santos
authors.affiliation: Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Evandro Mendes
authors.initials: EM
authors.lastname: Klumb
authors.affiliation: Systemic Autoimmune Diseases Research Unit, Hospital General Regional No. 36-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico ; Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
authors.forename: Mario García
authors.initials: MG
authors.lastname: Carrasco
authors.affiliation: Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Roger Abramino
authors.initials: RA
authors.lastname: Levy