Systemic lupus erythematosus: strategies to improve pregnancy outcomes

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with a high prevalence in females of childbearing age. Thus, reproduction in SLE patients is a major concern for clinicians. In the past, SLE patients were advised to defer pregnancy because of poor pregnancy outcomes and fear of SLE flares during pregnancy. Investigations to date show that maternal and fetal risks are higher in females with SLE than in the general population. However, with appropriate management of the disease, sufferers may have a relatively uncomplicated pregnancy course. Factors such as appropriate preconception counseling and medication adjustment, strict disease control prior to pregnancy, intensive surveillance during and after pregnancy by both the obstetrician and rheumatologist, and appropriate interventions when necessary play a key role. This review describes the strategies to improve pregnancy outcomes in SLE patients at different time points in the reproduction cycle (preconception, during pregnancy, and postpartum period) and also details the neonatal concerns.

Systemic Lupus Erythematosus and Pregnancy: A Single-Center Observational Study of 69 Pregnancies

“…In pregnant SLE patients, complications associated with the disease are often difficult to distinguish from physiological changes or complications arising from the pregnancy itself. 2,3 The association of SLE and antiphospholipid antibodies and antiphospholipid antibody syndrome (APS) further increases the probability of miscarriage, restricted intrauterine growth, mortality, and perinatal complications. 4 These antibodies are present in $ 25-50% of all SLE patients, but only a small proportion of patients with antiphospholipid antibodies develop APS.…”

Systemic Lupus Erythematosus and hearing disorders: Literature review and meta-analysis of clinical and temporal bone findings

“…The incidence of SLE is higher in women (82%–96%) than in men (4%–18%), 1 – 2 and it is two to three times more prevalent in people of African and Asian descent than those of European one. 3 Onset is most frequent from 20 to 39 years of age. 4 …”

“…SLE is a multifactorial pathology with different aetiologies, including genetic chromosome alterations, inflammation, drugs, environmental factors, and interactions between the adaptive and innate immune systems. 1 – 3 …”

Enteritis as initial manifestation of systemic lupus erythematosus in early pregnancy

“…The frequency of initial SLE manifestation in pregnancy is extremely low. [ 6 ] Only case reports and small series are available which reveal a high maternal morbidity and—depending on the gestational age at disease onset—a dismal fetal outcome. Clowse and Grotegut, [ 2 ] for example, found a diagnosis of SLE in 0.8% of deliveries in the USA between 2000 and 2003, with a maternal mortality of 1.1%.…”

“…Initial SLE manifestation during pregnancy is exceedingly rare and may be misdiagnosed as preeclampsia or any other disease, depending on the organ manifestations. [ 6 ] Autoimmune gastrointestinal complications do occur in patients with known SLE. A retrospective single-center analysis reports an incidence of 0.6%, [ 7 ] and a recent review gives a mortality rate of 2.7% in lupus enteritis, predominantly from complications of perforation.…”