Risk factors of systemic lupus erythematosus flares during pregnancy

Abstract

This review examines the risk factors for the development of systemic lupus erythematosus (SLE) flares during pregnancy. In preconception, anti-DNA, hypocomplementemia, previous thrombosis, triple antiphospholipid (aPL) antibody positivity, active lupus nephritis and discontinuation of medications such as hydroxychloroquine and azathioprine are factors associated with pregnancy failure. During pregnancy, SLE flares are associated with aPL antibodies, synergic changes of pregnancy on Th1 and TH2 cytokines, other cytokines and chemokines that interact with hormones such as estrogen and prolactin that amplify the inflammatory effect. From the clinical point of view, SLE activity at pregnancy onset, thrombocytopenia, lupus nephritis, arterial hypertension, aPL syndromes, preeclampsia is associated with lupus flares and fetal complications. In puerperium, the risk factors of flares are similar to pregnancy. Hyperactivity of immune system, autoantibodies, hyperprolactinemia, active lupus nephritis, decrease in TH2 cytokines with increase in TH1 cytokines probably participate in SLE flare. The SLE flares during pregnancy make the difference between an uncomplicated pregnancy and pregnancy with maternal and fetal complications. Therefore, the knowledge of risk factors leads the best treatment strategies to reduce flares and fetal complications in SLE patients.

Azathioprine during pregnancy in systemic lupus erythematosus patients is not associated with poor fetal outcome

“…These findings suggest that azathioprine is not only safe but also necessary to control the activity, and to reach a fetal outcome similar to patients not exposed to this drug. In fact, discontinuation of medications such as hydroxychloroquine and azathioprine is associated with poor fetal outcome [15].…”

Increased risk of systemic lupus erythematosus in pregnancy-induced hypertension

“…[26,44] Additionally, PIH is associated with increased risk for lupus flares during pregnancy or postpartum. [24,27] However, only a few studies have examined whether experiencing PIH is associated with an increased risk for developing SLE in the future. A Danish population-based cohort study revealed that the risk for developing any autoimmune disease was significantly increased among women with gestational hypertensive disorders (IRR = 1.21; 95% CI 1.16–1.26).…”

“…[24–26] Moreover, preeclampsia is associated with lupus flares. [24,27] Very few studies have examined the relationship between PIH and the risk of SLE. Therefore, we conducted a nationwide population-based retrospective cohort study to investigate the risk for developing SLE among patients who have had PIH.…”

Introduction to the special issue on the 9th International Congress on Autoimmunity

“…This special issue examined more conventional aspects of pregnancy in the context of autoimmunity. Two authors have questioned predictive factors of SLE flares as well as of obstetric and fetal complications during pregnancy [6,7]. Despite considerable progress in the identification of pre-conception, per pregnancy and puerperium risk factors for lupus flare, summarized by Jara et al [7], it appears that predictive factors in pregnancy have not been systematically and fully elucidated.…”

“…Two authors have questioned predictive factors of SLE flares as well as of obstetric and fetal complications during pregnancy [6,7]. Despite considerable progress in the identification of pre-conception, per pregnancy and puerperium risk factors for lupus flare, summarized by Jara et al [7], it appears that predictive factors in pregnancy have not been systematically and fully elucidated. However, by prospectively following 132 pregnancies in 96 SLE patients, Borella et al [6] reported that the number of flares before conception best predicted the risk of lupus flares during pregnancy.…”