A multidisciplinary approach to reproductive healthcare in women with rheumatic disease

Challenges in the Delivery Room: Integrated Analysis of Biomarkers Predicting Complications in Lupus Pregnancy

“…Furthermore, it is widely recognized that the management of reproductive issues in patients with rheumatic diseases commonly differs from general population, requiring a cross-over team with rheumatologists, specialists in the fields of obstetrics-gynecology and maternal-fetal medicine, and, in special cases, reproductive endocrinology and infertility [1][2][3][4]10]. Patients should be counseled about contraception, pregnancy and lactation; additionally, pregnancy in IMRDs needs to be planned and risks assessed in mother and child [1-4, 10, 11].…”

“…The outcomes of lupus pregnancies have dramatically improved over the last decade thanks to advance understanding of disease and its effects in the body, pregnancy planning, multidisciplinary management and close monitoring [1][2][3][4][5][6]. However, there are clear differences between pregnancy in general population and lupus pregnancy.…”

“…While a healthy pregnancy is widely defined by specific immunological and hormonal changes, underlying lupus pregnancy is characterized by higher serum pro-inflammatory cytokines, lesser Th2 polarization, lower estrogen and progesterone levels, lower number of T-Reg defective cells, blockade of complement inhibitors by anti-phospholipid antibodies (aPL), increased placental complement component deposition, aberrant activation and, finally, local inflammation. In another words, we talk about an altered physiological response, leading to significant pregnancy morbidity in lupus patients [1][2][3][4]10].…”

“…Furthermore, the physiological modulation of the immune system by pregnancy and related hormonal changes may interact with disease activity in autoimmune rheumatic disorders and drive complications (e.g. disease flares); on the other hand, lupus may have a significant impact on pregnancy outcomes [1,2,4,10]. Disease activity, severity of organ damage, antibody profile and drug treatment may promote maternal (e.g.…”

“…Pregnancy in lupus is still considered at increased risk for adverse pregnancy outcomes (APOs) [1][2][3][4][5][6][7][8][9][10]. Pregnant SLE-women can develop in 19-57% cases severe obstetric complications including spontaneous abortion (SA), preeclampsia (PE), intrauterine growth restriction (IUGR), small for gestational age (SGA), preterm birth, fetal death in utero and neonatal death.…”