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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

1999, Number 4

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An Med Asoc Med Hosp ABC 1999; 44 (4)

Lupus and pregnancy. Myths and evidences

Amigo CMC

Language: Spanish
References: 48
Page: 183-191
PDF size: 147.35 Kb.


ABSTRACT

Because systemic lupus erythematosus is frequent in young women, and because fertility is not affected in systemic lupus erythematosus, pregnant lupus patients are frequently encountered in clinical practice. Even though prognosis has improved considerably, pregnancy in systemic lupus erythematosus must be considered as high-risk and as such should be followed by a multidisciplinary team. There is still some controversy as to whether pregnancy impacts unfavorably on systemic lupus erythematosus activity. However, if there are exacerbations, they tend to be mild and well controlled with minor changes in medication. On the other hand, systemic lupus erythematosus activity associates with complications such as miscarriage, pre-term delivery, preeclampsia, and HELLP (Hemolysis, elevated liver enzymes and low platelets). Moreover, even in planned in inactive systemic lupus erythematosus, there may be maternal complications including arterial hypertension and preterm deliveries, as well as retarded intrauterine growth, prematurity, and neonatal lupus (from the transplacental passage of maternal SSA/Ro antibodies into the fetus). A successful pregnancy is not precluded by a history of renal disease. However, active lupus nephritis associates with pregnancy loss. It may be difficult to distinguish between active lupus nephritis, arterial hypertension induced by pregnancy, and preeclampsia. There is a strong correlation between the presence of aCL antibodies and/or lupus anticoagulant with fetal loss, preterm delivery, preeclampsia, and fetal growth retardation. In addition, a history of miscarriage is a strong predictor of a subsequent loss. Pregnancy in a lupus patient requires a close multidisciplinary surveillance to achieve best results. Treatment should be individualized. Prophylactic corticosteroids are not recommended. Treatment of an associated antiphospholipid syndrome should be treated on its merits. Despite its inherent risks, pregnancy is a viable option for the lupus patient.


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