| Lupus and pregnancy. | |
| | |
MedLine Citation:
|
PMID: 22112525 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
Systemic lupus erythematosus (SLE) disproportionately affects women in their reproductive age years. Pregnancy in this systemic autoimmune disease has long been associated with poor obstetric outcomes. However, the frequency of pregnancy loss in lupus has dropped to a level commensurate with that of the general US population. The outcomes of lupus pregnancies are better if conception is delayed until the disease has been inactive for at least 6 months, and the medication regimen has been adjusted in advance. Pregnancy in lupus is prone to complications, including flares of disease activity during pregnancy or in the postpartum period, preeclampsia, miscarriage, stillbirth, intrauterine growth retardation, and preterm birth. Active lupus nephritis poses the greatest risk. The recognition of a lupus flare during pregnancy may be difficult because the signs and symptoms may mimic those of normal pregnancy. Monitoring should include baseline and monthly laboratory tests, serial ultrasonography, fetal surveillance tests, and fetal m-mode echocardiography for mothers with SS-A (Ro) or SS-B (La) antibodies. In the absence of any signs or symptoms of active SLE, affected patients require no specific treatment during pregnancy. If hydroxychloroquine was in use before conception, it should be maintained throughout pregnancy. If a woman with SLE has antiphospholipid antibodies, prophylactic treatment with aspirin and/or low-molecular weight heparin is indicated to prevent fetal loss. Lupus flares during pregnancy are generally treated with hydroxychloroquine, low-dose prednisone, pulse intravenous methylprednisolone, and azathioprine. High-dose prednisone and cyclophosphamide are reserved for severe lupus complications but are associated with significant pregnancy-related complications and poor obstetrical outcomes. Target Audience: Obstetricians and Gynecologists and Family Physicians Learning Objectives: After completing the CME activity, physicians should be better able to provide preconception counseling to a woman with lupus, differentiate signs of a lupus flare from symptoms of pregnancy, differentiate preeclampsia from a flare of lupus nephritis, and differentiate the serious medical complications of pregnancy in a lupus patient. |
| | |
Authors:
|
Alan N Baer; Frank R Witter; Michelle Petri |
Related Documents
:
|
14586345 - Doppler predictors of adverse neonatal outcome in the growth restricted fetus at 34 wee... 16795125 - Reference ranges for doppler parameters of the fetal aortic isthmus during the second h... 20693805 - Effect of chorionic villus sampling on uterine artery doppler. 11530865 - Fetal thoracic aorta doppler in cases with intrauterine growth restriction. 20694885 - Maternal exposure to low-level heavy metals during pregnancy and birth size. 8627925 - An unusual coccidian parasite causing pneumonia in a northern cardinal (cardinalis card... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Obstetrical & gynecological survey Volume: 66 ISSN: 1533-9866 ISO Abbreviation: Obstet Gynecol Surv Publication Date: 2011 Oct |
Date Detail:
|
Created Date: 2011-11-24 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0401007 Medline TA: Obstet Gynecol Surv Country: United States |
Other Details:
|
Languages: eng Pagination: 639-53 Citation Subset: IM |
Affiliation:
|
*Associate Professor, Division of Rheumatology, Department of Medicine, †Professor, Department of Gynecology and Obstetrics, and ‡Professor, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Herpes simplex virus and pregnancy: a review of the management of antenatal and peripartum herpes in...
Next Document: Atopic dermatitis in pregnancy: current status and challenges.