DOCSLIB.ORG

Pregnancy-Related Challenges in Systemic Autoimmune Diseases

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pregnancy-Related Challenges in Systemic Autoimmune Diseases VOLUME 38 | NUMBER 5 | SEPTEMBER/OCTOBER 2015 The Art and Science of Infusion Nursing Mara Taraborelli, MD Doruk Erkan, MD, MPH Pregnancy-Related Challenges in Systemic Autoimmune Diseases ABSTRACT increase the risk of neonatal lupus erythemato- The awareness of pregnancy-related physiologic sus, eg, photosensitive rash and irreversible con- changes and complications is critical for the genital heart block. Antiphospholipid antibodies appropriate assessment and management of increase the risk of pregnancy morbidity, eg, pregnant patients with systemic autoimmune fetal loss and early preeclampsia. Pregnancy usu- diseases. The overlapping features of physiologic ally has a positive effect on rheumatoid arthritis; and pathological changes, selected autoantibod- however, a disease flare is common during the ies, and the use of potentially teratogenic medi- postpartum period. Both the rheumatologist and cations can complicate their management during the obstetrician should partner throughout the pregnancy. While pregnancy in lupus patients pregnancy to manage patients for successful presents an additional risk to an already complex outcomes. situation, in patients with no disease activity, the Key words: antiphospholipid syndrome, risk of a future pregnancy-related complication is connective tissue diseases, pregnancy, rheumatic relatively low. Anti-Ro and anti-La antibodies diseases, systemic lupus erythematosus ystemic autoimmune diseases (SADs) are rela- Pregnancy and disease outcomes during and after tively common in women of childbearing age. pregnancy of SAD patients have improved significantly Given the chronic relapsing nature of SADs, it in the past decades, as the result of a better understand- is more likely that a woman with an estab- ing of the diseases and the creation of multidisciplinary lished SAD will get pregnant than that a new teams—including rheumatologists, high-risk obstetri- SSAD will be diagnosed in a previously healthy pregnant cians, and neonatologists—experienced in autoimmune woman. diseases.1 However, the overlapping features of physio- logic and pathological changes during pregnancy, select- ed autoantibodies (eg, antiphospholipid [aPL] and anti- Author Affiliations: Spedali Civili di Brescia, Brescia, Italy (Dr Ro/La antibodies), and the teratogenicity of commonly Taraborelli); University of Brescia, Brescia, Italy (Dr Taraborelli); University of Pavia, Pavia, Italy (Dr Taraborelli); Barbara Volcker used immunosuppressive agents can complicate the Center for Women and Rheumatic Diseases, Hospital for Special management of patients with SADs during pregnancy. Surgery, New York, New York (Drs Erkan and Taraborelli); Weill The purpose of this review is to discuss the chal- Medical College, Cornell University, New York, New York (Dr Erkan). lenges health professionals may face while managing Mara Taraborelli, MD, is a rheumatology fellow at the Spedali Civili di Brescia and the University of Brescia in Italy. She is also pregnant patients with established SADs, as well as affiliated with the University of Pavia in Italy and the Hosptial for optimal medication management, including counseling Special Surgery in New York City. and safety. Doruk Erkan, MD, MPH, is an associate physician-scientist at the Barbara Volcker Center for Women and Rheumatic Diseases and an associate attending physician at the Hospital for Special Surgery in New York City, where he is also an associate professor of medicine PREGNANCY-RELATED at Weill Medical College of Cornell University. PHYSIOLOGIC CHANGES The authors have no conflicts of interest to disclose. Corresponding Author: Mara Taraborelli, MD, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25100, Brescia, Italy (mara. Pregnancy is an altered physiologic state characterized [email protected]). by particular signs, symptoms, and hormonal changes. DOI: 10.1097/NAN.0000000000000124 Various changes can occur during a normal pregnancy 360 Copyright © 2015 Infusion Nurses Society Journal of Infusion Nursing Copyright © 2015 Infusion Nurses Society. Unauthorized reproduction of this article is prohibited. JIN-D-14-00060.indd 360 28/08/15 9:48 PM The Art and Science of Infusion Nursing and create a challenge in the management of pregnant no disease activity is relatively low. Many SLE patients patients with SADs2: can undergo successful pregnancies without significant deterioration in their clinical status and with good fetal • Hemodynamic (intravascular volume increase, gener- outcome. alized edema) Case-control studies support little or no increased • Renal (glomerular filtration rate and urine protein risk for disease flare during pregnancy3; however, SLE increase) patients may flare any time during pregnancy, most • Cutaneous (palmar and facial erythema) often in the latter half, and in the postpartum period.4,5 • Musculoskeletal (arthralgia, back pain) Inactive disease for the 6 months preceding pregnancy • Hematologic (anemia, thrombocytopenia, leukocyto- is associated with a lower risk of disease flare6; the sis, erythrocyte sedimentation rate increase, pro- longer a patient is in remission, the better are her thrombotic profile) chances for completing a pregnancy without exacerba- • Immunologic (variation in the function of B cells, T tion. Hypertension and active kidney disease preceding cells, and monocytes; elevated complement [C]3 and pregnancy increase the risk of lupus renal flare and C4 levels) PEC7; renal insufficiency, in particular prepregnancy serum creatinine greater than 1.6 mg/dL, is an impor- PREGNANCY-RELATED tant risk factor for serious renal deterioration during PATHOLOGIC CHANGES pregnancy.8 Pregnancy is inadvisable in the setting of uncontrolled hypertension, progressive renal failure Some pregnancy-related complications are more com- (serum creatinine > 2.5 mg/dL or glomerular filtration mon in patients with SADs compared with the general rate < 35 mL/min), severe neurologic and cardiopulmo- population. Complications health professionals always nary involvement (pulmonary hypertension or severe should include in pregnancy-related discussions are: cardiomyopathy with ejection fraction < 30%-40% or severe restrictive lung disease with forced vital capacity • Preeclampsia (PEC): Blood pressure higher than < 50% of predicted), severe thrombocytopenia (< 140/90 mm Hg after 20 weeks of gestation on at 30,000/mm3), and teratogenic medications.9 least 2 occasions and proteinuria more than 300 Proteinuria during pregnancy requires careful evalu- mg/d ation. The differential diagnosis includes new onset or • HELLP (hemolysis, elevated liver enzymes, and low worsening lupus nephritis, PEC, or both. Differentiating platelet count) syndrome lupus flare from PEC can be challenging: rapid worsen- • Eclampsia: Seizures occurring in the setting of a PEC ing of proteinuria over days; microscopic hematuria • Preembryonic loss: Loss between conception through with erythrocyte casts; an increase in anti-dsDNA level, week 4 of gestation and extrarenal lupus activity, eg, lymphadenopathy, • Embryonic loss: Loss between weeks 5 through 9 rash, inflammatory arthritis, fever, or leukopenia sup- • Fetal loss: Loss between week 10 of gestation port lupus activity.10 Pregnancy-related rash may mimic through delivery a lupus rash as a result of palmar and facial erythema • Intrauterine growth restriction (IUGR): Ultrasound- from increased blood flow to the skin. Bland joint effu- assessed fetal abdominal circumference < 5th sion and diffuse arthralgias, common in pregnancy, may percentile be confused with lupus arthritis. • Preterm delivery: Delivery before week 37 The most common risks to the fetus in a lupus preg- nancy are fetal loss, prematurity, or IUGR.11 Fetal out- PREGNANCY IN SELECTED SADs come is related more to renal involvement, anti-Ro/La antibodies, and aPL, which is discussed below, than the Systemic Lupus Erythematosus occurrence of lupus flare. Proteinuria higher than 0.5 g per 24 hours is an independent predictor of poor fetal Systemic lupus erythematosus (SLE) is a multisystem outcome: fetal loss occurs in almost 60% of patients autoimmune disease with a wide spectrum of clinical with proteinuria as opposed to 10% of patients who do manifestations and a variable course characterized by not have proteinuria.7 Hypertension and thrombocyto- exacerbations and remissions. The disease can affect penia are additional risk factors for pregnancy loss in any organ system, including cutaneous, musculoskele- SLE patients.12 tal, cardiovascular, renal, and neurological systems. It is Anti-Ro (SS-A) and anti-La (SS-B) antibodies increase characterized by specific autoantibodies, eg, anti–dou- the risk of neonatal lupus erythematosus (NLE) consist- ble-stranded DNA (dsDNA) and anti-Smith antibodies. ing of photosensitive rash, thrombocytopenia, abnor- While pregnancy in SLE patients presents an addi- mal liver function tests, and rarely irreversible congeni- tional risk to an already complex situation, the risk of a tal heart block (CHB).13 With the exception of CHB, all pregnancy-related complication in stable patients with manifestations disappear with the clearance of maternal VOLUME 38 | NUMBER 5 | SEPTEMBER/OCTOBER 2015 Copyright © 2015 Infusion Nurses Society 361 Copyright © 2015 Infusion Nurses Society. Unauthorized reproduction of this article is prohibited. JIN-D-14-00060.indd 361 28/08/15 9:48 PM antibodies at about 4 to 6 months. During pregnancy, of pregnancies continue to experience pregnancy mor- maternal IgG anti-Ro/La are transferred through
Load more

Recommended publications
  • Maternal Systemic Lupus Erythematosus (SLE) High Risk for Preterm Delivery and Not for Long-Term Neurological Morbidity of the Offspring
    Journal of Clinical Medicine Article Maternal Systemic Lupus Erythematosus (SLE) High Risk for Preterm Delivery and Not for Long-Term Neurological Morbidity of the Offspring Dora Davidov 1, Eyal Sheiner 1,* , Tamar Wainstock 2, Shayna Miodownik 1 and Gali Pariente 1 1 Soroka University Medical Center, Department of Obstetrics and Gynecology, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; [email protected] (D.D.); [email protected] (S.M.); [email protected] (G.P.) 2 The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; [email protected] * Correspondence: [email protected] Abstract: Objective: Pregnancies of women with systemic lupus erythematosus (SLE) are associated with preterm delivery. As preterm delivery is associated with long-term neurological morbidity, we opted to evaluate the long-term neurologic outcomes of offspring born to mothers with SLE regardless of gestational age. Methods: Perinatal outcomes and long-term neurological disease of children of women with and without SLE during pregnancy were evaluated. Children of women with and without SLE were followed until 18 years of age for neurological diseases. Generalized estimating equation (GEE) models were used to assess perinatal outcomes. To compare cumulative neurological morbidity incidence a Kaplan–Meier survival curve was used, and a Cox proportional Citation: Davidov, D.; Sheiner, E.; hazards model was used to control for confounders. Result: A total of 243,682 deliveries were Wainstock, T.; Miodownik, S.; included, of which 100 (0.041%) were of women with SLE. Using a GEE model, maternal SLE was Pariente, G.
    [Show full text]
  • Obstetric Nephrology: Lupus and Lupus Nephritis in Pregnancy
    Obstetric Nephrology: Lupus and Lupus Nephritis in Pregnancy | Todd J. Stanhope,* Wendy M. White,† Kevin G. Moder,‡ Andrew Smyth,§ and Vesna D. Garovic Summary SLE is a multi-organ autoimmune disease that affects women of childbearing age. Renal involvement in the form of either active lupus nephritis (LN) at the time of conception, or a LN new onset or flare during pregnancy increases the risks of preterm delivery, pre-eclampsia, maternal mortality, fetal/neonatal demise, and intrauterine growth *Department of Obstetrics and restriction. Consequently, current recommendations advise that the affected woman achieve a stable remission of her Gynecology, Mayo renal disease for at least 6 months before conception. Hormonal and immune system changes in pregnancy may affect Clinic, Rochester, disease activity and progression, and published evidence suggests that there is an increased risk for a LN flare during Minnesota; †Division pregnancy. The major goal of immunosuppressive therapy in pregnancy is control of disease activity with medications of Maternal Fetal that are relatively safe for a growing fetus. Therefore, the use of mycophenolate mofetil, due to increasing evidence Medicine, Mayo Clinic, Rochester, supporting its teratogenicity, is contraindicated during pregnancy. Worsening proteinuria, which commonly occurs Minnesota; ‡Divisions in proteinuric renal diseases toward the end of pregnancy, should be differentiated from a LN flare and/or pre- of Rheumatology and | eclampsia, a pregnancy-specific condition clinically characterized by hypertension and proteinuria. These consid- Nephrology and erations present challenges that underscore the importance of a multidisciplinary team approach when caring for Hypertension, Department of these patients, including a nephrologist, rheumatologist, and obstetrician who have experience with these pregnancy- Medicine, Mayo related complications.
    [Show full text]
  • Lupus Eritematoso Sistémico En El Embarazo
    ARTÍCULO DE REVISIÓN Lupus eritematoso sistémico en el embarazo Daniela Stuht López,1 Samuel Santoyo Haro,2 Ignacio Lara Barragán3 Resumen Summary El lupus eritematoso sistémico (LES) es una enferme- Systemic lupus erythematosus (LES), is a chronic, dad crónica, multisistémica que se caracteriza por una infl ammatory and multisystemic disease characterized by respuesta autoinmune aberrante a autoantígenos con an aberrant autoimmune response to autoantigens that afección a cualquier órgano o tejido, que afecta princi- attacks any organ or tissue, affecting primarily women in palmente a mujeres en edad reproductiva. LES afecta reproductive age. In the United States of America, LES aproximadamente a 300,000 personas en los Estados affects nearly 300,000 people, primarily women with a ratio Unidos de América con relación mujer:hombre de 10:1. El female: male of 10:1. The aim of this article is to resume the objetivo de este artículo es revisar los principales riesgos primary risks of pregnancy associated to LES, as well as asociados al embarazo de pacientes con LES, así como the general recommendations for preconceptional period las recomendaciones generales en cuanto al periodo pre- and treatment during pregnancy and lactation. concepcional, el manejo general y farmacológico durante el embarazo y la lactancia. Palabras clave: Embarazo, lupus eritematoso sistémico, Key words: Pregnancy, systemic lupus erythematosus, fertilidad, tratamiento. fertility, treatment. INTRODUCCIÓN desencadenan una activación y proliferación de células inmunes innatas
    [Show full text]
  • Neonatal and Obstetrical Outcomes of Pregnancies in Systemic Lupus
    original article Oman Medical Journal [2018], Vol. 33, No. 1: 15-21 Neonatal and Obstetrical Outcomes of Pregnancies in Systemic Lupus Erythematosus Reem Abdwani 1*, Laila Al Shaqsi2 and Ibrahim Al-Zakwani3,4 1Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman 2Department of Pediatrics, Al Nahda Hospital, Muscat, Oman 3Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman 4Gulf Health Research, Muscat, Oman ARTICLE INFO ABSTRACT Article history: Objectives: Systemic lupus erythematous (SLE) is a chronic autoimmune disease Received: 30 July 2017 that affects women primarily of childbearing age. The objective of this study was Accepted: 17 October 2017 to determine the neonatal and maternal outcomes of pregnancies in SLE patients Online: compared to pregnancies in healthy controls. Methods: We conducted a retrospective DOI 10.5001/omj.2018.04 cohort study in a tertiary care hospital in Oman between January 2007 and December 2013. We analyzed 147 pregnancies and compared 56 (38.0%) pregnancies in women Keywords: Neonatal Systemic Lupus with SLE with 91 (61.9%) pregnancies in healthy control women. Disease activity was Erythematosus; Premature determined using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Infant; Intrauterine Growth Results: The mean age of the cohort was 30.0±5.0 years ranging from 19 to 44 years old. Retardation; Oman. Patients with SLE were treated with hydroxychloroquine (n = 41; 73.2%), prednisolone (n = 38; 67.8%), and azathioprine (n = 17; 30.3%). There was no disease activity in 39.2% (n = 22) of patients while 41.0% (n = 23), 12.5% (n = 7), and 7.1% (n = 4) had mild (SLEDAI 1–5), moderate (SLEDAI 6–10), and severe (SLEDAI ≥ 11) disease activity, respectively, at onset of pregnancy.
    [Show full text]
  • Multiple Intracranial Hemorrhages in Pregnancy
    Published online: 2019-09-25 Case Report Multiple intracranial hemorrhages in pregnancy: A common autoimmune etiology Hans Raj Pahadiya, Manoj Lakhotia, Ronak Gandhi, Akanksha Choudhary, Shiva Madan Department of Medicine, Dr. S.N. Medical College, Jodhpur, Rajasthan, India ABSTRACT Systemic lupus erythematosus (SLE) is an autoimmune disorder, primarily affect female in fertile age. Pregnancy in SLE female is a high‑risk situation which can adversely affect maternal‑fetal dyad. SLE can flare during pregnancy or in postpartum period. We describe a case of a young pregnant female who presented because of right hemiparesis due multiple hemorrhages in the brain. The first presentation of the SLE with multiple intracranial hemorrhages in pregnancy, preceding the other characteristic clinical symptoms is rare. Here, we high lighten the major neurological issues and maternal‑fetal dyad issues in SLE pregnancy and treatment strategies for management of SLE in pregnancy. Key words: Fetal loss, intracranial hemorrhage, maternal‑fetal dyad, pregnancy, systemic lupus erythematosus, thrombocytopenia Introduction psychological damage are underlying mechanisms for central nervous system manifestation of SLE.[4] The first Systemic lupus erythematosus (SLE) is a chromic, presentation of SLE with intracranial hemorrhage (ICH) multisystem autoimmune disorder with a female in the third trimester of pregnancy is a rare event. We preponderance, common in their teen to forties explain the ICH in our case because of immune‑mediated and diagnosed by the presence of standard criteria. thrombocytopenia in a newly diagnosed case of SLE. Pregnancy in a woman suffering with SLE, have higher risk situation. Pregnancy can exacerbate or flare the Case Report SLE. The SLE adversely affects the outcome of the pregnancy.
    [Show full text]
  • SLE and Pregnancy
    21 SLE and Pregnancy Hanan Al-Osaimi and Suvarnaraju Yelamanchili King Fahad Armed Forces Hospital, Jeddah Saudi Arabia 1. Introduction Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs. Disease flares can occur at any time during pregnancy and postpartum without any clear pattern. The hormonal and physiological changes that occur in pregnancy can induce lupus activity. Likewise the increased inflammatory response during a lupus flare can cause significant complications in pregnancy. Distinguishing between signs of lupus activity and pregnancy either physiological or pathological can be difficult [Clowse, 2007]. Pregnancy is a crucial issue that needs to be clearly discussed in details in all female patients with SLE who are in the reproductive age group. There are two essential concerns. The first one is the Lupus activity on pregnancy and the second one is the influence of pregnancy on Lupus. That is the reason why pregnancy should be planned at least six months of remission with close follow-up for SLE flares. Women with SLE usually have complicated pregnancies out of which one third will result in cesarean section, one third will have preterm delivery and more than 20% will be complicated by preeclampsia [Clowse, 2006; Clark, 2003]. Rarely an SLE patient with a controlled disease activity may deteriorate as pregnancy advances, but still the pregnancy outcome can be better if pregnancy is well timed and managed. 2. Physiology of pregnancy There are increased demands by the mother, fetus and the placenta during pregnancy which is to be met by the mother’s organ systems. Therefore there are some cardiovascular, hematological, immunological, endocrinal and metabolic changes in the mother in normal pregnancy.
    [Show full text]
  • And Pregnancy
    7 LUPUS and Pregnancy © LUPUSUK 2015 LUPUS and pregnancy Is pregnancy possible when you have lupus? Yes, many lupus patients have successful pregnancies however lupus may sometimes affect fertility and lupus pregnancies can sometimes end in miscarriage or stillbirth. This leaflet is a generalised guide to “lupus and pregnancy” and it is important that you discuss any plans with your doctor before you become pregnant, so that your care can be individu- alised. What should I do if I want to become pregnant? Lupus is a disease that can potentially affect many different organs in the body and the disease can affect people in different ways. Its course may be influenced by the state of pregnancy and a pregnancy can be influenced by lupus. As with all pregnancies, it is generally advisable to make sure that you are as fit as possible before pregnancy. It is also sensible to stop taking tobacco and alcohol and to take folic acid supplements before getting pregnant. It is advisable to consult your doctor about how stable your lupus is, as it is best to wait at least six months after a flare before becoming pregnant. This is because it has been found that the pregnancy is more likely to be successful when your disease is well controlled and stable. If your lupus is newly diagnosed it is also advisable to wait for the disease to become stable before becoming pregnant for the same reason. Before you become pregnant it is important that all the medications that you are taking are reviewed by your doctor.
    [Show full text]
  • Evaluation and Management of Systemic Lupus Erythematosus and Rheumatoid Arthritis During Pregnancy Medha Barbhaiya, Bonnie L
    Clinical Immunology (2013) 149, 225–235 available at www.sciencedirect.com Clinical Immunology www.elsevier.com/locate/yclim REVIEW Evaluation and management of systemic lupus erythematosus and rheumatoid arthritis during pregnancy Medha Barbhaiya, Bonnie L. Bermas⁎ Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA Received 23 December 2012; accepted with revision 11 May 2013 Available online 23 May 2013 KEYWORDS Abstract Women of childbearing age are at risk for developing systemic rheumatic diseases. Pregnancy; Pregnancy can be challenging to manage in patients with rheumatic diseases for a variety of Systemic lupus reasons including the impact of physiological and immunological changes of pregnancy on erythematosus; underlying disease activity, the varied presentation of rheumatic disease during pregnancy, and Rheumatoid arthritis; the limited treatment options. Previously, patients with rheumatic disease were often advised Fertility; against pregnancy due to concerns of increased maternal and fetal morbidity and mortality. Treatment However, recent advancements in the understanding of the interaction between pregnancy and rheumatic disease have changed how we counsel patients. Patients with rheumatic disease can have successful pregnancy outcomes, particularly when a collaborative approach between the rheumatologist and obstetrician is applied. This review aims to discuss the effect of pregnancy on patients with the most common rheumatic diseases, the effect of these diseases on the pregnancy itself, and the management of these patients during pregnancy. © 2013 Published by Elsevier Inc. Contents 1. Introduction ......................................................... 226 1.1. Physiologic changes during pregnancy ....................................... 226 1.2. Physical changes of pregnancy ........................................... 226 1.3. Laboratory findings .................................................. 226 1.4.
    [Show full text]
  • Systemic Lupus Erythematosus and Pregnancy: Clinical Evolution
    Fernanda Garanhani de Castro Systemic lupus erythematosus Surita Mary Ângela Parpinelli and pregnancy: clinical evolution, Ema Yonehara Fabiana Krupa maternal and perinatal outcomes José Guilherme Cecatti and placental fi ndings Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil ORIGINAL ARTICLE INTRODUCTION OBJECTIVE ABSTRACT Systemic lupus erythematosus (SLE) is The objective of the present study was to an autoimmune disease of unknown etiology evaluate the clinical evolution, perinatal out- CONTEXT AND OBJECTIVE: Systemic lupus erythematosus is a chronic disease that is more that can affect various organs and systems. comes and most frequently observed placental frequent in women of reproductive age. The Since it predominantly affects women (in alterations among pregnant lupus patients, relationship between lupus and pregnancy is the proportions of 9 to 1) and since in the according to the presence or absence of disease problematic: maternal and fetal outcomes are worse than in the general population, and majority of cases it is diagnosed between fl are-ups. These women were receiving care the management of fl are-ups is diffi cult during the ages of 20 and 40, it is the connective tissue at a specialized prenatal clinic, Centro de this period. The aim here was to compare the disease that is most frequently associated with Atenção Integral à Saúde da Mulher (Women’s outcomes of 76 pregnancies in 67 women with pregnancy and the puerperium. Remission Full Healthcare Clinic), Universidade Estadual lupus, according to the occurrence or absence of fl are-ups. of the disease around the time of conception de Campinas (CAISM/Unicamp), over an 1,2 DESIGN AND SETTING: An observational cohort is related to favorable pregnancy outcome.
    [Show full text]
  • Understanding and Managing Pregnancy in Patients with Lupus
    Hindawi Publishing Corporation Autoimmune Diseases Volume 2015, Article ID 943490, 18 pages http://dx.doi.org/10.1155/2015/943490 Review Article Understanding and Managing Pregnancy in Patients with Lupus Guilherme Ramires de Jesus,1 Claudia Mendoza-Pinto,2,3 Nilson Ramires de Jesus,1 Flávia Cunha dos Santos,1 Evandro Mendes Klumb,4 Mario García Carrasco,2,3 and Roger Abramino Levy4 1 DepartmentofObstetrics,UniversidadedoEstadodoRiodeJaneiro,RiodeJaneiro,Brazil 2Systemic Autoimmune Diseases Research Unit, Hospital General Regional No. 36-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico 3Department of Immunology and Rheumatology, Medicine School, Benemerita´ Universidad Autonoma´ de Puebla, Puebla, Mexico 4Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil Correspondence should be addressed to Guilherme Ramires de Jesus; [email protected] Received 1 April 2015; Accepted 31 May 2015 Academic Editor: Juan-Manuel Anaya Copyright © 2015 Guilherme Ramires de Jesus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE.
    [Show full text]
  • Lupus Eritematoso Sistémico En El Embarazo
    www.medigraphic.org.mx ARTÍCULO DE REVISIÓN Lupus eritematoso sistémico en el embarazo Daniela Stuht López,1 Samuel Santoyo Haro,2 Ignacio Lara Barragán3 Resumen Summary El lupus eritematoso sistémico (LES) es una enferme- Systemic lupus erythematosus (LES), is a chronic, dad crónica, multisistémica que se caracteriza por una infl ammatory and multisystemic disease characterized by respuesta autoinmune aberrante a autoantígenos con an aberrant autoimmune response to autoantigens that afección a cualquier órgano o tejido, que afecta princi- attacks any organ or tissue, affecting primarily women in palmente a mujeres en edad reproductiva. LES afecta reproductive age. In the United States of America, LES aproximadamente a 300,000 personas en los Estados affects nearly 300,000 people, primarily women with a ratio Unidos de América con relación mujer:hombre de 10:1. El female: male of 10:1. The aim of this article is to resume the objetivo de este artículo es revisar los principales riesgos primary risks of pregnancy associated to LES, as well as asociados al embarazo de pacientes con LES, así como the general recommendations for preconceptional period las recomendaciones generales en cuanto al periodo pre- and treatment during pregnancy and lactation. concepcional, el manejo general y farmacológico durante el embarazo y la lactancia. Palabras clave: Embarazo, lupus eritematoso sistémico, Key words: Pregnancy, systemic lupus erythematosus, fertilidad, tratamiento. fertility, treatment. INTRODUCCIÓN desencadenan una activación y proliferación
    [Show full text]
  • Lupus and Pregnancy
    LIVING WITH LUPUS UPUS AND PREGNANCY L When is the best time for me to become pregnant? • The best time to get pregnant is when you are the healthiest. If you have active kidney problems or other serious lupus problems, your pregnancy could be difficult. It might be hard to find medicines for you that would be safe for your developing baby. Will it be hard to get pregnant because I have lupus? • Some medicines such as cyclophosphamide (Cytoxan®) decrease your chance to become pregnant. If you have received Cytoxan® in the past, you should discuss this with your doctor. Will I have a flare of my lupus when I am pregnant? • If your disease has been well controlled for six or more months, it is likely you will not have a flare during your pregnancy. There are some ‘normal ‘symptoms of pregnancy such as aching joints, hair changes, rashes, swelling of the legs, and a feeling of warmth. These symptoms could be confused with a flare. Be sure to tell your rheumatologist or obstetrician all your symptoms. What medicines are safe for me to take while I am pregnant? • All medicines and supplements should be used only with close monitoring from your doctor. Talk to your doctor about your medicines before you become pregnant. o Generally safe: prednisone, prednisolone, methylprednisolone, hydroxychloroquine (plaquenil), acetaminophen (Tylenol®), NSAIDs such as ibuprofen and naproxen may be taken for the first half of pregnancy. o Unsafe: cyclophosphamide, methotrexate, leflunomide, coumadin (warfarin), ACE inhibitors (Lisinopril, Ramipril, etc) Do I need to start any new medicines when I am pregnant? • You should take prenatal vitamins with extra calcium and folate (folic acid).
    [Show full text]