Immunosuppression in pregnant women with systemic lupus erythematosus

Ponticelli, Claudio; Moroni, Gabriella

doi:10.1586/1744666x.2015.1033404

Cited by 33 publications

(14 citation statements)

References 20 publications

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“…The shift from mycophenolate to azathioprine should be done at least 6 weeks before pregnancy in order to minimize the risk of SLE flares due to this change of therapy [215, 216]. Patients should start the pregnancy with the lowest possible dosage of the allowed drugs.…”

Section: Specific Diseases: Lupus Nephritis As a Prototype Of Systemimentioning

confidence: 99%

A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy

Castellino²,

et al. 2016

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Pregnancy is increasingly undertaken in patients with chronic kidney disease (CKD) and, conversely, CKD is increasingly diagnosed in pregnancy: up to 3 % of pregnancies are estimated to be complicated by CKD. The heterogeneity of CKD (accounting for stage, hypertension and proteinuria) and the rarity of several kidney diseases make risk assessment difficult and therapeutic strategies are often based upon scattered experiences and small series. In this setting, the aim of this position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature, and discuss the experience in the clinical management of CKD in pregnancy. CKD is associated with an increased risk for adverse pregnancy-related outcomes since its early stage, also in the absence of hypertension and proteinuria, thus supporting the need for a multidisciplinary follow-up in all CKD patients. CKD stage, hypertension and proteinuria are interrelated, but they are also independent risk factors for adverse pregnancy-related outcomes. Among the different kidney diseases, patients with glomerulonephritis and immunologic diseases are at higher risk of developing or increasing proteinuria and hypertension, a picture often difficult to differentiate from preeclampsia. The risk is higher in active immunologic diseases, and in those cases that are detected or flare up during pregnancy. Referral to tertiary care centres for multidisciplinary follow-up and tailored approaches are warranted. The risk of maternal death is, almost exclusively, reported in systemic lupus erythematosus and vasculitis, which share with diabetic nephropathy an increased risk for perinatal death of the babies. Conversely, patients with kidney malformation, autosomal-dominant polycystic kidney disease, stone disease, and previous upper urinary tract infections are at higher risk for urinary tract infections, in turn associated with prematurity. No risk for malformations other than those related to familiar urinary tract malformations is reported in CKD patients, with the possible exception of diabetic nephropathy. Risks of worsening of the renal function are differently reported, but are higher in advanced CKD. Strict follow-up is needed, also to identify the best balance between maternal and foetal risks. The need for further multicentre studies is underlined.

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Section: Specific Diseases: Lupus Nephritis As a Prototype Of Systemimentioning

confidence: 99%

A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy

Castellino²,

et al. 2016

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“…However concern remains about the fetal toxicity when the mothers receive prolonged treatments with high-dose glucocorticoids or develop pre-eclampsia. We feel that doses of prednisone (or equivalent agents) <20 mg daily may be considered safe for the mother and newborn [12]. Prednisone is compatible with breastfeeding.…”

Section: Glucocorticoidsmentioning

confidence: 99%

Fetal Toxicity of Immunosuppressive Drugs in Pregnancy

Ponticelli

Moroni

2018

JCM

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Women affected by autoimmune diseases, organ transplantation, or neoplasia need to continue immunosuppressive treatment during pregnancy. In this setting, not only a careful planning of pregnancy, but also the choice of drugs is critical to preventing maternal complications and minimizing the fetal risks. Some immunosuppressive drugs are teratogenic and should be replaced even before the pregnancy, while other drugs need to be managed with caution to prevent fetal risks, including miscarriage, intrauterine growth restriction, prematurity, and low birth weight. In particular, the increasing use of biologic agents raises the question of their compatibility with reproduction. In this review we present data on the indication and safety in pregnancy of the most frequently used immunosuppressive drugs.

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“…26 In fact, there were many reports that the use of such immunosuppressive agents didn't increase the incidence of congenital malformations. [27][28][29] Nevertheless, these agents have not been approved for use in pregnant patients and were often discontinued during pregnancy for many years in Japan. Recently, AZP, TAC and CyA have finally been approved for use during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of fetal and maternal pregnancy outcomes in Japanese patients with systemic lupus erythematosus

Irino

Arinobu

Ayano

et al. 2021

Lupus

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Objective The number of pregnant and delivery cases in systemic lupus erythematosus (SLE) patients are increasing due to the advances in therapies. However, there are many problems such as the exacerbation of SLE during pregnancy and the risk of fetal complications. We investigated the impact of both pregnancy on lupus and lupus on pregnancy in Japanese patients. Methods We retrospectively analyzed 64 pregnancies in 39 cases of lupus patients at Kyushu University Hospital, Japan, from October 2002 to July 2018 and then assessed the clinical profiles and maternal and fetal outcomes. Results In terms of the impact of pregnancy on SLE, 29.7% of patients had lupus flare during pregnancy. Multivariate analysis showed that flare rates were significantly higher in patients who discontinued the immunosuppressants when pregnancy was detected or before pregnancy. Pregnancy results were 25.0% for preterm birth, 39.1% for low birth weight infants, and 31.3% for small-for-gestational-age infants. Regarding the effect of SLE on fetal death, the rates of stillbirth were significantly higher in cases whose C3 value at 12 weeks of gestation was lower than before conception. Preterm birth was associated with disease duration and lupus flare during pregnancy. Conclusions Discontinuation of immunosuppressive drugs was a predictive factor for lupus flare during pregnancy. Further, the decrease of C3 levels at 12 weeks of gestation from baseline was a predictive factor for fetal loss. It is essential for lupus pregnant patients to prevent flares, even with the use of immunosuppressive medications.

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Immunosuppression in pregnant women with systemic lupus erythematosus

Cited by 33 publications

References 20 publications

A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy

A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy

Fetal Toxicity of Immunosuppressive Drugs in Pregnancy

Predictive factors of fetal and maternal pregnancy outcomes in Japanese patients with systemic lupus erythematosus

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