Lupus and Pregnancy

被引:73
作者
Baer, Alan N. [1 ]
Witter, Frank R. [2 ]
Petri, Michelle [1 ]
机构
[1] Johns Hopkins Univ, Sch Med, Div Rheumatol, Dept Med, Baltimore, MD 21239 USA
[2] Johns Hopkins Univ, Sch Med, Dept Gynecol & Obstet, Baltimore, MD 21239 USA
关键词
CONGENITAL HEART-BLOCK; CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME; THROMBOTIC THROMBOCYTOPENIC PURPURA; NEONATAL LUPUS; INTRAVENOUS IMMUNOGLOBULIN; CYCLOPHOSPHAMIDE THERAPY; OVULATION INDUCTION; REVISED CRITERIA; DISEASE-ACTIVITY; HELLP-SYNDROME;
D O I
10.1097/OGX.0b013e318239e1ee
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Systemic lupus erythematosus (SLE) disproportionately affects women in their reproductive age years. Pregnancy in this systemic autoimmune disease has long been associated with poor obstetric outcomes. However, the frequency of pregnancy loss in lupus has dropped to a level commensurate with that of the general US population. The outcomes of lupus pregnancies are better if conception is delayed until the disease has been inactive for at least 6 months, and the medication regimen has been adjusted in advance. Pregnancy in lupus is prone to complications, including flares of disease activity during pregnancy or in the postpartum period, preeclampsia, miscarriage, stillbirth, intrauterine growth retardation, and preterm birth. Active lupus nephritis poses the greatest risk. The recognition of a lupus flare during pregnancy may be difficult because the signs and symptoms may mimic those of normal pregnancy. Monitoring should include baseline and monthly laboratory tests, serial ultrasonography, fetal surveillance tests, and fetal m-mode echocardiography for mothers with SS-A (Ro) or SS-B (La) antibodies. In the absence of any signs or symptoms of active SLE, affected patients require no specific treatment during pregnancy. If hydroxychloroquine was in use before conception, it should be maintained throughout pregnancy. If a woman with SLE has antiphospholipid antibodies, prophylactic treatment with aspirin and/or low-molecular weight heparin is indicated to prevent fetal loss. Lupus flares during pregnancy are generally treated with hydroxychloroquine, low-dose prednisone, pulse intravenous methylprednisolone, and azathioprine. High-dose prednisone and cyclophosphamide are reserved for severe lupus complications but are associated with significant pregnancy-related complications and poor obstetrical outcomes. Target Audience: Obstetricians and Gynecologists and Family Physicians Learning Objectives: After completing the CME activity, physicians should be better able to provide preconception counseling to a woman with lupus, differentiate signs of a lupus flare from symptoms of pregnancy, differentiate preeclampsia from a flare of lupus nephritis, and differentiate the serious medical complications of pregnancy in a lupus patient.
引用
收藏
页码:639 / 653
页数:15
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