Pregnancy-Related Challenges in Systemic Autoimmune Diseases.
The awareness of pregnancy-related physiologic changes and complications is critical for the appropriate assessment and management of pregnant patients with systemic autoimmune diseases. The overlapping features of physiologic and pathological changes, selected autoantibodies, and the use of potentially teratogenic medications can complicate their management during pregnancy. While pregnancy in lupus patients presents an additional risk to an already complex situation, in patients with no disease activity, the risk of a future pregnancy-related complication is relatively low. Anti-Ro and anti-La antibodies increase the risk of neonatal lupus erythematosus, eg, photosensitive rash and irreversible congenital heart block. Antiphospholipid antibodies increase the risk of pregnancy morbidity, eg, fetal loss and early preeclampsia. Pregnancy usually has a positive effect on rheumatoid arthritis; however, a disease flare is common during the postpartum period. Both the rheumatologist and the obstetrician should partner throughout the pregnancy to manage patients for successful outcomes.
Spedali Civili di Brescia, Brescia, Italy (Dr Taraborelli); University of Brescia, Brescia, Italy (Dr Taraborelli); University of Pavia, Pavia, Italy (Dr Taraborelli); Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, New York, New York (Drs Erkan and Taraborelli); Weill Medical College, Cornell University, New York, New York (Dr Erkan). Mara Taraborelli, MD, is a rheumatology fellow at the Spedali Civili di Brescia and the University of Brescia in Italy. She is also affiliated with the University of Pavia in Italy and the Hosptial for Special Surgery in New York City. Doruk Erkan, MD, MPH, is an associate physician-scientist at the Barbara Volcker Center for Women and Rheumatic Diseases and an associate attending physician at the Hospital for Special Surgery in New York City, where he is also an associate professor of medicine at Weill Medical College of Cornell University.
Mara
M
Taraborelli
Doruk
D
Erkan
D001323:Autoantibodies; D001327:Autoimmune Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D011295:Prenatal Care; D012307:Risk Factors
D001323:Autoantibodies