Safety issues and recommendations for successful pregnancy outcome in systemic lupus erythematosus. (September 2018)

• Record Type: Journal Article
• Authors: Nahal, Simran Kaur; Selmi, Carlo; Gershwin, M. Eric
• Is Part Of: Journal of autoimmunity. Volume 93(2018)
• Page Start: 16
• Page End: 23
• Publication Date: 2018-09
• Subjects: Rheumatology -- Infertility -- Miscarriage -- Teratogenicity -- Anti-phospholipid; Autoimmunity -- Periodicals; Autoimmune diseases -- Periodicals; Autoantibodies -- Periodicals; Autoimmune Diseases -- Periodicals; Auto-immunité -- Périodiques; Maladies auto-immunes -- Périodiques; Electronic journals; 616.978005
• DOI: 10.1016/j.jaut.2018.07.016
• Languages: English
• ISSNs: 0896-8411

Abstract

Abstract: Systemic lupus erythematosus (SLE) primarily affects women of childbearing age. One of the major changes in SLE focuses on the timing of a successful pregnancy. In the past, pregnancy was strongly discouraged in SLE, especially in the presence of risk factors such as nephritis, use of immunosuppressive therapies, or positivity of specific autoantibodies such as anti-phospholipids and anti-Ro/SSA, La/SSBA. Thanks to our better knowledge on the disease and management, pregnancy success rates in SLE patients have significantly improved care by the a multidisciplinary team which fosters a successful pregnancy with minimal complications for the mother and fetus when the disease is inactive or in remission. This approach is based on a counseling phase before pregnancy, to assess SLE activity phase, specific medications, risk factors, and continues through pregnancy and lactation with significantly improved pregnancy outcomes. Further, we can now better define the risk of disease flares during pregnancy based on a better understanding of the changes in maternal immunity and its relationship with SLE-associated autoimmunity and chronic inflammation. There is wide consensus that women with SLE can have successful pregnancies as long as conception is planned in a phase of inactive disease, and when the patient is closely managed by a rheumatologist, high-risk OB/GYN, neonatologist, and other medical specialists as indicated. Preconception counseling is essential to assess the risk of both fetal and maternal complications as well as identify life-threatening contraindications. Particular attention should be used in those SLE cases that have nephritis, APS or positivity for aPL, pulmonary hypertension, and positive anti-Ro/SSA or anti-La/SSB antibodies. In conclusion, the use of specific guidelines on the management of SLE before and during pregnancy and lactation, and a better understanding of the use of immunosuppressive therapies have significantly increased pregnancy success. Highlights: While pregnancy was previously discouraged in SLE, reproductive success rates have now significantly improved. The counseling phase before pregnancy is crucial to assess SLE activity phase and provide an ideal timing for conception. The risk of disease flares during pregnancy remains but can now be better predicted. Women with SLE can have successful pregnancies as long as conception is planned in a phase of inactive disease. Attention is needed in nephritis, positive aPL, pulmonary hypertension, positive anti-Ro/SSA or anti-La/SSB antibodies.