Maternal and Fetal Outcome of Lupus Pregnancy: A Prospective Study of 29 Pregnancies

Abstract

Maternal thrombophilia is an accepted risk factor for perinatal death, having been associated with pregnancy-related thrombosis and preeclampsia, intrauterine growth restriction, placental abruption, recurrent miscarriage, and late fetal loss. Up to two thirds of these vascular complications can be related to some form of inherited or acquired thrombophilia. It is not clear whether paternal factors contribute to thrombophilia-related perinatal mortality. The investigators examined data from a prospective registry of perinatal mortality in The Netherlands. Seventy-four women with a previous perinatal death and 54 of their male partners were assessed, along with 71 women having uneventful pregnancies and 66 of their partners.Cases and control subjects did not differ with respect to age or oral contraceptive use. Compared with control women, case women had significant higher rates of antithrombin deficiency (12% vs. 0%), elevated factor VIII activity (43% vs. 17%), and increased activated protein C (APC) resistance (32% vs. 6%). Total protein S antigen also was increased in case women. There were no significant group differences in the prevalence of deficient protein C activity, hyperhomocysteinemia, factor V G1691A (F V Leiden) mutation, prothrombin mutation, or the MTHFR C677T mutation. The overall prevalence of one or more thrombophilic factors was 70% in case women and 30% in control women. Male cases had significantly increased APC resistance compared with the male control group (22% vs. 0%). Of 54 couples with past perinatal mortality, 30 (55%) had more than one thrombophilic abnormality compared with 10 (17%) of control couples.The prevalence of thrombophilia is about doubled not only in mothers, but also in fathers having a history of perinatal mortality, suggesting that it is a risk factor. ABSTRACTTobacco contains many mutagenic compounds, and tobacco-specific metabolites have recently been found in fetal blood and cell-free amniotic fluid. This study examined possible genotoxic effects of maternal smoking on amniotic fluid cells. Chromosomal instability in the form of chromosomal gaps and breaks was sought along with structural chromosomal abnormalities. Amniocytes were obtained by amniocentesis in a prospective series of 25 women who had smoked 10 or more cigarettes a day for at least 10 years and in 25 nonsmokers. Two independent observers assessed 494Obstetrical and Gynecological Survey ABSTRACTThe authors retrospectively analyzed pregnancies after uterine artery embolization in the course of an ongoing prospective observational study. Twenty-nine pregnancies occurred in 671 women who underwent this procedure-all done by the same interventional radiologist. Detailed information was available for 24 of the 26 completed pregnancies (three pregnancies at less than 8 weeks gestation at the time of analysis were excluded).Seven pregnancies, 27% of those analyzed, ended in miscarriage. In addition, there were two terminations and one ectopic pregnancy. First-trimester bleeding occurred in 40% of 16 pregnanci...

Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia

“…Most studies have shown that lupus tends to flare during pregnancy and after pregnancy; in some patients flares were mild such as arthritis, constitutional and cutaneous manifestations, and in others they were more serious problems affecting the kidneys and central nervous system. 6,9,17,34 Lupus flare in pregnancy was found to be related to adverse pregnancy outcomes including pregnancy loss, preterm delivery and IUGR in our patients, consistent with previous reports. 8 This was the strongest predictor of all the adverse pregnancy outcomes among the characteristics we compared.…”

Long-term remission after successful pregnancy in autologous peripheral blood stem cell transplanted system lupus erythematosus patients

“…While we cannot document these two cases as "complement remission", more clinical practices and long-term follow-up for the other 9 cases are necessary, to see whether autologous hematopoietic stem cell transplantation can lead to SLE remission for a long-term duration or even cure the disease completely. It should be acknowledged that SLE is a multifactor autoimmune disease processes with polygenic susceptibility background [14] being modulated by environmental factors such as estrogen levels [7,[14][15][16], which might all aVect the whole strategy and outcome of autologous hematopoietic stem cell transplantation. This also could explain why some SLE cases relapse following transplantation.…”

“…SLE disease activity may become severe at postpartum period [7]. Maternal risks have been more diYcult to evaluate because of the unpredictable nature of the disease and limited individual experience.…”

“…SLE Xare during pregnancy consistently aVects pregnancy outcome [1][2][3]7]. SLE disease activity may become severe at postpartum period [7].…”

Fausses couches spontanées précoces répétées : quelle prise en charge proposer en 2006 ?

“…), à la présence des autoanticorps et à la toxicité éventuelle des traitements proposés [41]. [42,43]. Les études in vitro évoquent une toxicité directe des antiphospholipides sur le développement embryonnaire et trophoblastique, avec des défauts d'invasion expliquant les FCS pré-coces et les pathologies placentaires plus tardives [44].…”