Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study

Moroni, Gabriella; Doria, Andrea; Giglio, Elisa; Tani, Chiara; Zen, Margherita; Strigini, Francesca Anna Letizia; Zàina, Barbara; Tincani, Anǵela; Liso, Federica de; Matinato, Caterina; Grossi, Claudia; Gatto, Mariele; Castellana, Paola; Limardo, Monica; Meroni, Pier Luigi; Messa, Piergiorgio; Ravani, Pietro; Mosca, Marta

doi:10.1016/j.jaut.2016.07.010

Cited by 106 publications

(100 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, any maternal disease flare and renal flare were estimated to occur in 26% and 16% of pregnancies, respectively. A recent prospective multicenter cohort study of 71 pregnancies in 61 women with lupus nephritis reported an increased odds for preterm delivery by 15% for each increase of proteinuria by 1 g/d every trimester (20). Even low C3 and C4, without systemic manifestations, have been reported to be associated with increased risk in a prospective cohort (21).…”

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 99%

“…Unlike the other primary glomerular diseases, there are now robust data to inform pregnancy outcomes and guide a management approach, including a systematic review (2) and two large multicenter prospective studies (19,20) as well as numerous smaller retrospective analyses. The take-home message from all of these studies is that women with active disease should be strongly discouraged from conceiving until their lupus is controlled.…”

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 99%

“…Hydroxychloroquine is recommended to be commenced or continued for all women with lupus nephritis because prospective cohort studies have shown maternal and fetal benefits (20,21). Those who discontinue hydroxychloroquine have been reported to have higher incidence of lupus flares, leading to greater use of antenatal steroids (27).…”

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 99%

“…As such, there are no reported adverse effects on the fetus or neonate. Furthermore, there are limited data to suggest up to an 85% reduction in the risk of fetal growth restriction (20) and recurrence of fetal heart block (29).…”

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 99%

“…Despite lack of data in the primary glomerular diseases, recent evidence from the Predictors of Pregnancy Outcome in Systemic Lupus Erythematosus and Antiphospholipid Syndrome (PROMISSE) Study (19) and other smaller studies in systemic lupus (20) and even vasculitis (30) that show much better outcomes in women with adequately controlled disease before pregnancy have indirectly informed care in other glomerular diseases (Figure 1). Prepregnancy optimization is defined as stabilization of rapid progression where possible, minimization of urine protein with pregnancy-compatible immunosuppression, and control of hypertension with pregnancy-safe antihypertensive agents, while actively delaying pregnancy when these conditions cannot be met.…”

Section: Management Recommendationsmentioning

confidence: 99%

See 4 more Smart Citations

Pregnancy and Glomerular Disease

Blom

Odutayo

Bramham

et al. 2017

CJASN

View full text Add to dashboard Cite

During pregnancy, CKD increases both maternal and fetal risk. Adverse maternal outcomes include progression of underlying renal dysfunction, worsening of urine protein, and hypertension, whereas adverse fetal outcomes include fetal loss, intrauterine growth restriction, and preterm delivery. As such, pregnancy in young women with CKD is anxiety provoking for both the patient and the clinician providing care, and because the heterogeneous group of glomerular diseases often affects young women, this is an area of heightened concern. In this invited review, we discuss pregnancy outcomes in young women with glomerular diseases. We have performed a systematic review in attempt to better understand these outcomes among young women with primary GN, we review the studies of pregnancy outcomes in lupus nephritis, and finally, we provide a potential construct for management. Although it is safe to say that the vast majority of young women with glomerular disease will have a live birth, the counseling that we can provide with respect to individualized risk remains imprecise in primary GN because the existing literature is extremely dated, and all management principles are extrapolated primarily from studies in lupus nephritis and diabetes. As such, the study of pregnancy outcomes and management strategies in these rare diseases requires a renewed interest and a dedicated collaborative effort.

show abstract

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 99%

Section: Overview Of Pregnancy Outcomes In Lupus Nephritismentioning

confidence: 99%