title: A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus.
abstract: Nowadays, most of the young women affected by Systemic Lupus Erythematosus (SLE) can carry out one or more pregnancies thanks to the improvement in treatment and the consequent reduction in morbidity and mortality. Pregnancy outcome in these women has also greatly improved in the last decades. A correct timing for pregnancy (tailored on disease activity and established during a preconception counselling), together with a tight monitoring during the three trimesters and the post-partum period (to timely identify and treat possible obstetric complications or maternal disease flares), as well as the concept of multidisciplinary management, are currently milestones of the management of pregnancy in SLE patients. Nevertheless, the increasing knowledge on the compatibility of drugs with pregnancy has allowed a better treatment of these patients, by choosing medications that control maternal disease activity without harming the foetus. However, particular attention and strict monitoring should be dedicated to SLE pregnant women in particular clinical settings: patients with lupus nephritis and patients with aPL positivity or Antiphospholipid syndrome, who are at higher risk for maternal and foetal complications, but also patients with anti-Ro/SSA and/or anti-La/SSB antibodies, because of the risk of neonatal lupus. A discussion on family planning, as well as counselling on contraception, should be part of the everyday-practice for physicians caring for SLE women during their reproductive age. Another issue is the possible reduction of fertility in these women, that can be due to different reasons. Consequently, the request for assisted reproduction techniques has been increasing in the last years, so that rheumatologists and gynaecologists should be prepared to counsel SLE patients also in this particular setting.
authors.affiliation: Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Lazzaroni
authors.affiliation: Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Dall'Ara
authors.affiliation: Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Fredi
authors.affiliation: Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Nalli
authors.affiliation: Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Reggia
authors.affiliation: Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Obstetrics and Gynaecology, Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lojacono
authors.affiliation: Obstetrics and Gynaecology, Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ramazzotto
authors.affiliation: Obstetrics and Gynaecology, Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Zatti
authors.affiliation: Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Andreoli
authors.affiliation: Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. Electronic address: angela.tincani@unibs.it.
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
mesh_terms: D016736:Antiphospholipid Syndrome / Q000150:complications / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology; D003267:Contraception; D003376:Counseling; D019468:Disease Management; D005260:Female; D005298:Fertility; D006801:Humans; D007774:Lactation; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D008181:Lupus Nephritis / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D011256:Pregnancy Outcome; D027724:Reproductive Techniques, Assisted
chemical_list: D001323:Autoantibodies
keywords: Antiphospholipid antibodies; Counselling; Lupus nephritis; Neonatal lupus; Pregnancy; Systemic lupus erythematosus