title: Pregnancy and contraception in systemic and cutaneous lupus erythematosus.
abstract: A causal link has long been described between estrogen and systemic lupus erythematosus activity. Contraceptive and pregnancy management is now common for lupus patients, but pregnancy continues to be associated with higher maternal and fetal mortality/morbidity in systemic lupus erythematosus patients than among the general population. Potential complications include lupus flares, obstetric complications (fetal loss, in utero growth retardation, premature birth) and neonatal lupus syndrome. Association with antiphospholipid antibodies or antiphospholipid syndrome increases the risk of obstetric complications. Anti-SSA and/or anti-SSB antibodies put fetuses at risk for neonatal lupus. Improving the outcome of such pregnancies depends upon optimal systematic planning of pregnancy at a preconception counseling visit coupled with a multidisciplinary approach. Absence of lupus activity, use of appropriate medication during pregnancy based on the patient's medical history and risk factors, and regular monitoring constitute the best tools for achieving a favorable outcome in such high-risk pregnancies. The aim of this review is to provide an update on the management of contraception and pregnancy in systemic lupus erythematosus, cutaneous lupus and/or antiphospholipid syndrome in order to reduce the risk of complications and to ensure the best maternal and fetal prognosis.
authors.affiliation: Department of internal medicine, medical center, reference center for rare systemic and autoimmune diseases, hôpital Cochin, AP-HP, université René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
authors.forename: G
authors.initials: G
authors.lastname: Guettrot-Imbert
authors.affiliation: Department of internal medicine, medical center, reference center for rare systemic and autoimmune diseases, hôpital Cochin, AP-HP, université René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
authors.forename: N
authors.initials: N
authors.lastname: Morel
authors.affiliation: Department of internal medicine, medical center, reference center for rare systemic and autoimmune diseases, hôpital Cochin, AP-HP, université René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
authors.forename: V
authors.initials: V
authors.lastname: Le Guern
authors.affiliation: Endocrine gynaecology unit, hôpital Cochin-Port-Royal, AP-HP, université René-Descartes, 52, avenue de l'Observatoire, 75679 Paris cedex 14, France.
authors.forename: G
authors.initials: G
authors.lastname: Plu-Bureau
authors.affiliation: Université Pierre-et-Marie-Curie, Paris 6, 75013 Paris, France; Department of dermatology-allergology, hôpital Tenon, Paris public hospitals, 4, rue de la Chine, 75020 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Frances
authors.affiliation: Department of internal medicine, medical center, reference center for rare systemic and autoimmune diseases, hôpital Cochin, AP-HP, université René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France. Electronic address: nathalie.costedoat@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Costedoat-Chalumeau
mesh_terms: D017152:Antibodies, Antiphospholipid / Q000097:blood; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications; D003267:Contraception; D004452:Echocardiography; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D008178:Lupus Erythematosus, Cutaneous / Q000150:complications* / Q000628:therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000151:congenital / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D049590:Postpartum Period; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000209:etiology; D011379:Prognosis; D016216:Ultrasonography, Prenatal
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants
keywords: Adverse obstetrical outcome; Anti-SSA antibodies; Anticorps anti-SSA; Antiphospholipid syndrome; Complications obstétricales; Consultation pré-conceptionnelle; Contraception; Grossesse; Lupus systémique; Lupus érythémateux; Preconception counseling; Pregnancy; Syndrome des antiphospholipides; Systemic lupus erythematosus