Pregnancy in systemic lupus erythematosus

Abstract

Objectives: Systemic lupus erythematosus (SLE) is a chronic illness that often affects women of reproductive age. The objectives of this article are to review the impact of SLE on pregnancy and current management strategies, including commonly used therapies. Methods: We conducted a review of available literature on the clinical course of SLE, diagnosis, management and pregnancy complications. Results: SLE has a variable clinical course characterized by flares and periods of remission and can present unique challenges in the management of obstetric patients. Pregnancy in patients with SLE is associated with multiple risks, including fetal loss, preterm birth, fetal growth restriction, and hypertensive disease. With advancements in disease treatment, many women have favorable pregnancy outcomes, but appropriate preconception counseling and disease management remain important tools in reducing complications. Conclusion: Given the implications SLE can have on women of reproductive age and in pregnancy, understanding the disease course and management is important in order to optimize pregnancy outcomes.

Association between maternal multimorbidity and preterm birth, low birth weight and small for gestational age: a prospective birth cohort study from the Japan Environment and Children’s Study

“…57 In addition, the associations between other chronic diseases such as hypertension, kidney disease, and autoimmune disease and PTB are similar to the association between obesity and PTB. [20][21][22][23] Therefore, we hypothesised that each chronic condition that composes multimorbidity, such as underweight, obesity, psychiatric disorder and domestic violence, played an intermediate or direct role in perinatal outcomes, and that the combination of these chronic conditions might further increase the risk of adverse perinatal outcomes. 2…”

“…It has been widely known that maternal physical morbidity such as hypertension, kidney disease and systemic lupus erythematosus increase the risk of preterm births (PTBs) and low birthweight (LBW) infants. [20][21][22][23] Moreover, maternal psychological and social morbidity have been also associated with PTB and LBW. [24][25][26][27][28][29] In their review, McCauley et al were trying to assess the impact of each type of morbidity on women's health and wellbeing during pregnancy and after childbirth; however, a meta-analysis of the associations between multimorbidity and obstetrical complications could not be performed because of the heterogeneity of each study.…”

Lupus Eritematosus Sistemik (LES) pada Kehamilan

“…Intervensi ini dapat mengurangi kejadian keguguran hingga 50%. 8,9,14 Trimester Kedua dan Ketiga Menurut pedoman, rekomendasi ultrasonografi anatomi fetus pada trimester kedua dilakukan di sekitar usia gestasi 20 minggu. Karena adanya peningkatan risiko blok jantung kongenital, maka ekokardiografi fetus dan penentuan interval PR fetus setiap 1-2 minggu antara usia gestasi 16 dan 28 minggu dapat dipertimbangkan.…”

“…Wanita dengan komplikasi kehamilan retardasi pertumbuhan harus menjalani pemeriksaan pertumbuhan fetus setiap 3-4 minggu disertai velosimetri Doppler arteri umbilikal. 8,9,14 Persalinan LES sendiri bukan merupakan indikasi untuk persalinan preterm atau early-term. Adanya risiko tinggi untuk komplikasi kehamilan menyebabkan banyak pasien dengan LES dapat memiliki indikasi persalinan sebelum usia kehamilan 39 minggu akibat retardasi pertumbuhan atau penyakit hipertensi.…”

“…Prednison dengan dosis maintenance 5-10 mg per hari biasanya dianggap aman untuk bayi. 2,7,8 Azathioprine (AZA)…”