Flares of systemic lupus erythematosus during pregnancy and the puerperium: Prevention, diagnosis and management

Research output: Contribution to journalArticle

Abstract

Systemic lupus erythematosus is a systemic autoimmune disease that primarily affects women in their reproductive age years. Pregnancy in systemic lupus erythematosus now has favorable outcomes for the majority of women. However, flares of disease activity, preeclampsia, fetal loss, intrauterine growth retardation and preterm birth are established risks of such pregnancies. Active lupus nephritis at the time of conception poses the greatest risk for disease flares and poor obstetric outcomes. Patients should delay conception until their lupus has been in remission for at least 6 months. In addition, certain lupus medications are potentially teratogenic and need to be stopped before conception. The signs and symptoms of a lupus flare may mimic those of normal pregnancy, impeding its recognition during pregnancy. Hydroxychloroquine, low-dose prednisone, pulse intravenous methylprednisolone and azathioprine are commonly used to treat lupus flares during pregnancy.

Original languageEnglish (US)
Pages (from-to)439-453
Number of pages15
JournalExpert Review of Clinical Immunology
Volume8
Issue number5
DOIs
StatePublished - Jul 2012

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Systemic Lupus Erythematosus
Postpartum Period
Pregnancy
Hydroxychloroquine
Fetal Movement
Lupus Nephritis
Fetal Growth Retardation
Premature Birth
Methylprednisolone
Azathioprine
Prednisone
Pre-Eclampsia
Autoimmune Diseases
Obstetrics
Signs and Symptoms

Keywords

  • disease activity
  • lupus
  • preeclampsia
  • pregnancy
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

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abstract = "Systemic lupus erythematosus is a systemic autoimmune disease that primarily affects women in their reproductive age years. Pregnancy in systemic lupus erythematosus now has favorable outcomes for the majority of women. However, flares of disease activity, preeclampsia, fetal loss, intrauterine growth retardation and preterm birth are established risks of such pregnancies. Active lupus nephritis at the time of conception poses the greatest risk for disease flares and poor obstetric outcomes. Patients should delay conception until their lupus has been in remission for at least 6 months. In addition, certain lupus medications are potentially teratogenic and need to be stopped before conception. The signs and symptoms of a lupus flare may mimic those of normal pregnancy, impeding its recognition during pregnancy. Hydroxychloroquine, low-dose prednisone, pulse intravenous methylprednisolone and azathioprine are commonly used to treat lupus flares during pregnancy.",
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