Clinical and serological risk factors of systemic lupus erythematosus outcomes during pregnancy

Gaballa, Hala A.; El-Shahawy, Eman E.; Atta, Doaa S; Gerbash, Ehab Foad

doi:10.1016/j.ejr.2012.04.004

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…As standard good practice, we strongly suggest counseling women with RMD who are considering pregnancy regarding the improved maternal and fetal outcomes (based on many studies) associated with entering pregnancy with quiescent/low activity disease ( ). As additional good practice, we suggest maintaining concurrent care with specialists in obstetrics‐gynecology, maternal‐fetal medicine, neonatology, and other specialists as appropriate.…”

Section: Results/recommendationsmentioning

confidence: 99%

“…The American College of Obstetricians and Gynecologists and US Protective Health Task Force recommend aspirin 81 mg daily as prophylaxis in all patients at high risk for preeclampsia . Treatment with low‐dose aspirin during pregnancy to prevent or delay the onset of gestational hypertensive disease is recommended for those with SLE or APS because of their increased risk and may be considered for women with other RMD diagnoses depending on individual clinical risk factors.…”

Section: Results/recommendationsmentioning

confidence: 99%

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2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Sammaritano

Bermas

Chakravarty

et al. 2020

Arthritis & Rheumatology

458

520

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Objective To develop an evidence‐based guideline on contraception, assisted reproductive technologies (ART), fertility preservation with gonadotoxic therapy, use of menopausal hormone replacement therapy (HRT), pregnancy assessment and management, and medication use in patients with rheumatic and musculoskeletal disease (RMD). Methods We conducted a systematic review of evidence relating to contraception, ART, fertility preservation, HRT, pregnancy and lactation, and medication use in RMD populations, using Grading of Recommendations Assessment, Development and Evaluation methodology to rate the quality of evidence and a group consensus process to determine final recommendations and grade their strength (conditional or strong). Good practice statements were agreed upon when indirect evidence was sufficiently compelling that a formal vote was unnecessary. Results This American College of Rheumatology guideline provides 12 ungraded good practice statements and 131 graded recommendations for reproductive health care in RMD patients. These recommendations are intended to guide care for all patients with RMD, except where indicated as being specific for patients with systemic lupus erythematosus, those positive for antiphospholipid antibody, and/or those positive for anti‐Ro/SSA and/or anti‐La/SSB antibodies. Recommendations and good practice statements support several guiding principles: use of safe and effective contraception to prevent unplanned pregnancy, pre‐pregnancy counseling to encourage conception during periods of disease quiescence and while receiving pregnancy‐compatible medications, and ongoing physician‐patient discussion with obstetrics/gynecology collaboration for all reproductive health issues, given the overall low level of available evidence that relates specifically to RMD. Conclusion This guideline provides evidence‐based recommendations developed and reviewed by panels of experts and RMD patients. Many recommendations are conditional, reflecting a lack of data or low‐level data. We intend that this guideline be used to inform a shared decision‐making process between patients and their physicians on issues related to reproductive health that incorporates patients’ values, preferences, and comorbidities.

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Section: Results/recommendationsmentioning

confidence: 99%

Section: Results/recommendationsmentioning

confidence: 99%

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Sammaritano

Bermas

Chakravarty

et al. 2020

Arthritis & Rheumatology

458

520

View full text Add to dashboard Cite

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“…Specific conditions might contraindicate pregnancy due to high risk of maternal morbidity or mortality. End-stage organ damage such as heart failure, moderate to severe renal insufficiency (creatinine more than 2.8 mg/dL), severe pulmonary hypertension (estimated systolic pulmonary arterial pressure more than 50 mmHg or symptomatic) or pulmonary restriction, history of a stroke or major thrombosis in the last 2 years are such conditions [ 15 , 41 , 42 , 43 , 44 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach

et al. 2022

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Pregnancy is one of the most challenging processes the human body is exposed to: the healthy mother can carry to term a genetically different new-born, while her immune system adapts to tolerate this new status and avoids rejection. In autoimmune disorders, motherhood is even more challenging, with additional medical counselling, mother care, and foetus development checks being necessary. While the aspects of supplementary mother care and pregnancy progress tracking are associated with well-established medical procedures and protocols, counselling, be it pre- or post-conception, is still underestimated and scarcely applied. Indeed, over the past decades, medical counselling for this particular population has changed significantly, but from a healthcare’s provider point of view, more is required to ensure a smooth, controllable pregnancy evolution. One of the most frequent autoimmune diseases affecting young females during their fertile years is Systemic Lupus Erythematosus (SLE). Like other heterogenous diseases, it exposes the mother to severe, organ-threatening complications and unpredictable evolution. Both the disease and its treatment can significantly affect the mother’s willingness to engage in a potentially risky pregnancy, as well as the likeliness to carry it to term without any impairments. A good collaboration between the patient’s rheumatologist and obstetrician is therefore mandatory in order to: (a) allow the mother to make an informed decision on pursuing with the pregnancy; (b) ensure a perfect synchronization between pregnancy terms and treatment; and (c) avoid or minimize potential complications. The best approach to achieve these outcomes is pregnancy planning. Moreover, knowing one desired prerequisite for a successful pregnancy evolution in SLE mothers is a stable, inactive, quiescent disease for at least six months prior to conception, planning becomes more than a recommended procedure. One particular aspect that requires attention before conception is the treatment scheme applied before delivery as autoantibodies can influence significantly the course of pregnancy. In this view, future SLE mothers should ideally benefit from preconception counselling within their agreed care pathway. A multidisciplinary team including at least the rheumatologist and obstetrician should be employed throughout the pregnancy, to decide on the appropriate timing of conception and compatible medication with respect to disease activity, as well as to monitor organ involvement and foetus development progress.

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“…31 The risk of flare seems to be related to the occurrence of disease activity 6-12 months before conception. 15,19,22,24,30 A higher risk of flare during pregnancy is noticed when lupus nephritis occurs at conception, even in women in remission. 13,21,24,30 One study showed a 30% flare rate during pregnancy or postpartum among 113 pregnancies in women with preexisting lupus nephritis evaluated; other studies suggest a likelihood of up to 60%.…”

Section: Disease Activity During Prenatal Care (Flares)mentioning

confidence: 99%

“…Small-for-gestational-age is a more common outcome in those born prematurely, but can occur at all gestational ages. 20,22,37,39 Several studies concluded that the small-for-gestational-age rate outcome among SLE women tends to be higher, condition strongly associated to the presence of disease flare-ups during pregnancy. 23 Serial obstetric sonography is the most important method to guide surveillance for fetal growth.…”

Section: Evaluation Of Fetal Growth and Vitalitymentioning

confidence: 99%

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

Pastore

Costa

Parpinelli

et al. 2018

Rev Bras Ginecol Obstet

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Clinical and serological risk factors of systemic lupus erythematosus outcomes during pregnancy

Cited by 9 publications

References 31 publications

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach

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

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