A Critical Review on Obstetric Follow-up of Women Affected by Systemic Lupus Erythematosus

Pastore, Danilo Eduardo Abib; Costa, Maria Laura; Parpinelli, Mary Ângela; Surita, Fernanda Garanhani

doi:10.1055/s-0038-1625951

Cited by 19 publications

(21 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a healthy SLE pregnancy, the woman should be offered the chance to a spontaneous labor, at term, with vaginal delivery [75]. Maternal medication may need a special adjustment for labor: intravenous hydrocortisone to overcome its physiological stress, discontinuation of LMWH, for which the timing will condition regional anesthesia.…”

Section: Maternal Complications Of Postpartum Slementioning

confidence: 99%

“…Pregnant women with SLE are more likely to have a cesarean section (unplanned), high blood pressure, pre-eclampsia, spontaneous abortion, thromboembolic events, and infections [20]. In patients under corticosteroids at immunosuppressive dose (≥1 mg/Kg), prophylactic antibiotics is recommended, due to the risk of infections and sepsis [75].…”

Section: Maternal Complications Of Postpartum Slementioning

confidence: 99%

See 1 more Smart Citation

Systemic Lupus Erythematosus Pregnancy

Fernandes¹,

Bernardino²,

Taulaigo³

et al. 2021

Lupus - Need to Know

View full text Add to dashboard Cite

Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown etiology that often affects women during childbearing age. Pregnant women with SLE are considered high-risk patients, with pregnancy outcomes being complicated by high maternal and fetal mortality and morbidity. Obstetric morbidity includes preterm birth, fetal growth restriction (FGR), and neonatal lupus syndromes. Active SLE during conception is a strong predictor of adverse pregnancy outcomes and exacerbations of disease can occur more frequently during gestation. Therefore, management of maternal SLE should include preventive strategies to minimize disease activity and to reduce adverse pregnancy outcomes. Patients with active disease at time of conception have increased risk of flares, like lupus nephritis, imposing a careful differential diagnosis of pre-eclampsia, keeping in mind that physiological changes of pregnancy may mimic a lupus flare. Major complications arise when anti-phospholipid antibodies are present, like recurrent pregnancy loss, stillbirth, FGR, and thrombosis in the mother. A multidisciplinary approach is hence crucial and should be initiated to all women with SLE at childbearing age with an adequate preconception counseling with assessment of risk factors for adverse maternal and fetal outcomes with a tight pregnancy monitoring plan. Although treatment choices are limited during pregnancy, prophylactic anti-aggregation and anticoagulation agents have proven beneficial in reducing thrombotic events and pre-eclampsia related morbidity. Pharmacological therapy should be tailored, allowing better outcomes for both the mother and the baby. Immunosuppressive and immunomodulators, must be effective in controlling disease activity and safe during pregnancy. Hydroxychloroquine is the main therapy for SLE due to its anti-inflammatory and immunomodulatory effects recommended before and during pregnancy and other immunosuppressive drugs (e.g. azathioprine and calcineurin inhibitors) are used to control disease activity in order to improve obstetrical outcomes. Managing a maternal SLE is a challenging task, but an early approach with multidisciplinary team with close monitoring is essential and can improve maternal and fetal outcomes.

show abstract

Section: Maternal Complications Of Postpartum Slementioning

confidence: 99%

Section: Maternal Complications Of Postpartum Slementioning

confidence: 99%

Systemic Lupus Erythematosus Pregnancy

Fernandes¹,

Bernardino²,

Taulaigo³

et al. 2021

Lupus - Need to Know

View full text Add to dashboard Cite

show abstract

“…The onset of SLE is more frequent in the first years of reproduction, and it is advised to avoid pregnancy when the disease is active. Premature ovarian failure (persistent amenorrhea with elevated levels of follicle-stimulating hormone before age 40) may be of autoimmune etiology in the general population but is rarely associated with systemic autoimmune diseases such as SLE [1,2]. The study of anti-ovarian antibodies has contributed little to this pathology.…”

Section: Systemic Lupus Erythematosus Fertilitymentioning

confidence: 99%

“…Prepregnancy information and collaboration between specialists, such as obstetricians and perinatologists, are essential to optimize maternal and fetal outcomes in SLE pregnancies. In this chapter, important issues related to fertility, optimal time of conception, risk of disease flare during pregnancy, course of pregnancy, fetal outcome, safety of various medications used to control SLE during pregnancy and lactation, and a contraceptive education are discussed [1].…”

Section: Introductionmentioning

confidence: 99%

Lupus Pregnancy: Risk Factors and Management

Ordi-Ros¹,

Marce²,

Cortés-Hernández³

2020

Lupus - New Advances and Challenges

View full text Add to dashboard Cite

Systemic lupus erythematosus (SLE) mainly affects women in the fertile age of life. A patient with SLE is as fertile as the general population except for treatment with drugs with ovarian toxicity, severe flare of the disease, or autoimmune oophoritis for anti-ovarian antibodies. Pregnancy in a woman with SLE implies greater maternal and fetal mortality and morbidity. Fetal loss, premature birth, intrauterine growth restriction associated with antiphospholipid antibodies (aPL), and neonatal lupus associated with anti-Ro are important fetal problems. Similarly, preeclampsia and lupus nephritis may lead to diagnostic confusion. Treatment options during pregnancy are limited to a few safe medications, which further restricts options. The loss of refractory pregnancy associated with antiphospholipid antibodies and the complete heart block associated with anti-Ro antibodies remain unresolved problems. The planning of pregnancy with sustainable treatments during pregnancy, no flare of SLE in the previous 6 months, and absence of nephritis are important for a good maternal and fetal prognosis. A gestation planning, multidisciplinary approach, and close monitoring are essential to obtain optimal results.

show abstract

“…The risk of disease relapse is increased to 20% during pregnancy. Also, in women with SLE, pregnancy is associated with increased risk of adverse fetal and maternal outcomes, including fetal loss, prematurity, low birth weight, congenital heart block, postpartum hemorrhage, and need to blood transfusion (2)(3)(4). Therefore, family planning and contraception are especially important in women with SLE and should be explained to patients soon after the diagnosis of SLE.…”

Section: Introductionmentioning

confidence: 99%

Contraceptive Prevalence and Consulting Service in Women with Systemic Lupus Erythematosus: A Cross-Sectional Study

Mobini¹,

Tahamtan²,

Salehi³

et al. 2021

Ethiop J Health Sci

View full text Add to dashboard Cite

BACKGROUND: Systemic lupus erythematosus (SLE), often affects women of childbearing age. Family planning consultation is a major aspect of medical care in these patients because of the risk of disease activation and poor pregnancy and fetal outcomes. The aim of the present study was to evaluate contraceptive prevalence and consulting service in women with SLE.METHODS: In a cross-sectional study, a total of 144 female patients with SLE, ages 15-50, who were presented to rheumatology clinics in Sari, north of Iran, were evaluated. The study was conducted between March 2019 and May 2020. Patients' clinico-demographic profile and fertility information were obtained. Disease activity and damage were assessed by the systemic lupus erythematosus disease activity (SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI).RESULTS: One hundred and forty-four SLE patients of childbearing age participated in this study. From 102 patients with the possibility of pregnancy, 36(35.2%) received contraceptive consultations in last year. Withdrawal was the most prevalent contraceptive method (41.7%), followed by permanent (11.8%), and barrier methods (9%). There were no significant differences in age, disease duration, marriage duration, SDI or SLEDAI scores between the women who received or not received contraceptive counseling (P>0.05).CONCLUSION: Many SLE patients did not receive adequate information about contraception, and it may be associated with many adverse effects on disease activity and pregnancy outcomes. Therefore, contraceptive consultation as an important aspect of patient’s management is strongly suggested.

show abstract

A Critical Review on Obstetric Follow-up of Women Affected by Systemic Lupus Erythematosus

Cited by 19 publications

References 39 publications

Systemic Lupus Erythematosus Pregnancy

Systemic Lupus Erythematosus Pregnancy

Lupus Pregnancy: Risk Factors and Management

Contraceptive Prevalence and Consulting Service in Women with Systemic Lupus Erythematosus: A Cross-Sectional Study

Contact Info

Product

Resources

About