Lupus and pregnancy can present some particular challenges for both mother and child. While most infants born to mothers who have lupus are healthy, mothers with lupus as a

pre-existing disease in pregnancy A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy (such as causing pregnancy complicat ...

should remain under medical care until delivery. In general, women with lupus and, in addition, hypertension,

proteinuria Proteinuria is the presence of excess proteins in the urine. In healthy persons, urine contains very little protein; an excess is suggestive of illness. Excess protein in the urine often causes the urine to become foamy (although this symptom ma ...

, and

azotemia Azotemia (''azot'', "nitrogen" + '' -emia'', "blood condition") is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compou ...

have an extra increased risk for pregnancy complications. Pregnancy outcomes in women with lupus who receive kidney transplants are similar to those of transplant recipients without lupus. Women pregnant and known to have anti-Ro (SSA) or anti-La antibodies (SSB) often have echocardiograms during the 16th and 30th weeks of pregnancy to monitor the health of the heart and surrounding vasculature.

Contraception Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...

and other reliable forms of pregnancy prevention is routinely advised for women with lupus, since getting pregnant during active disease was found to be harmful.

Lupus nephritis Lupus nephritis is an inflammation of the kidneys caused by systemic lupus erythematosus (SLE), an autoimmune disease. It is a type of glomerulonephritis in which the glomeruli become inflamed. Since it is a result of SLE, this type of glomerulo ...

was the most common manifestation. Of live births, approximately one third are delivered prematurely.

Miscarriage

Lupus causes an increased rate of fetal death ''in utero'' and spontaneous abortion (miscarriage). The overall live-birth rate in somebody with lupus has been estimated to be 72%. Pregnancy outcome appears to be worse in those with lupus whose disease flares up during pregnancy. Miscarriages in the

first trimester Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

appear either to have no known cause or to be associated with signs of active lupus.Lupus and Pregnancy
by Michelle Petri. The Johns Hopkins Lupus Center. Retrieved May 2011 Later losses appear to occur primarily due to the

antiphospholipid syndrome Antiphospholipid syndrome, or antiphospholipid antibody syndrome (APS or APLS), is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies. APS provokes blood clots (thrombosis) in both arteries and veins as well as pregnancy-r ...

, in spite of treatment with heparin and

aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and/or inflammation, and as an antithrombotic. Specific inflammatory conditions which aspirin is used to treat inc ...

. All women with lupus, even those without previous history of miscarriage, are recommended to be screened for

antiphospholipid antibodies Antiphospholipid syndrome, or antiphospholipid antibody syndrome (APS or APLS), is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies. APS provokes blood clots (thrombosis) in both arteries and veins as well as pregnancy-r ...

, both the

lupus anticoagulant Lupus anticoagulant is an immunoglobulin that binds to phospholipids and proteins associated with the cell membrane. Its name is a partial misnomer, as it is actually a prothrombotic antibody ''in vivo''. Lupus anticoagulant in living systems c ...

(the RVVT and sensitive PTT are the best screening battery) and anticardiolipin antibodies.

Neonatal lupus

Neonatal lupus Neonatal lupus erythematosus is an autoimmune disease in an infant born to a mother with anti-Ro/SSA and with or without anti-La/SSB antibodies. The disease most commonly presents with a rash resembling subacute cutaneous lupus erythematosus and ...

is the occurrence of lupus symptoms in an infant born from a mother with lupus, most commonly presenting with a rash resembling

discoid lupus erythematosus Discoid lupus erythematosus is the most common type of chronic cutaneous lupus (CCLE), an autoimmune skin condition on the lupus erythematosus spectrum of illnesses. It presents with red, painful, inflamed and coin-shaped patches of skin with a sc ...

, and sometimes with systemic abnormalities such as

heart block Heart block (HB) is a disorder in the heart's rhythm due to a fault in the natural pacemaker. This is caused by an obstruction – a block – in the electrical conduction system of the heart. Sometimes a disorder can be inherited. Despite the se ...

hepatosplenomegaly Hepatosplenomegaly (commonly abbreviated HSM) is the simultaneous enlargement of both the liver (hepatomegaly) and the spleen (splenomegaly). Hepatosplenomegaly can occur as the result of acute viral hepatitis, infectious mononucleosis, and his ...

.thefreedictionary.com > neonatal lupus
Citing: Dorland's Medical Dictionary for Health Consumers. Copyright 2007 Neonatal lupus is usually benign and self-limited. Still, identification of mothers at highest risk for complications allows for prompt treatment before or after birth. In addition, lupus can flare up during pregnancy, and proper treatment can maintain the health of the mother for longer.

Aggravation of lupus

Aggravation (or exacerbation) of lupus has been estimated to occur in about 20-30% pregnancies where the mother has lupus. Increased disease activity of lupus is expected during pregnancy because of increased levels of

estrogen Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal ac ...

prolactin Prolactin (PRL), also known as lactotropin, is a protein best known for its role in enabling mammals to produce milk. It is influential in over 300 separate processes in various vertebrates, including humans. Prolactin is secreted from the pit ...

, and certain cytokines. However, a long time of remission before pregnancy decreases the risk of aggravation, with an incidence of 7-33% in women who have been in remission for at least 6 months, and an incidence of 61-67% in women who have active lupus at the time of conception. Renal disease flare-up is the most common presentation of lupus aggravation in pregnancy, and is seen equally in United States and European populations.

Serositis Serositis refers to inflammation of the serous tissues of the body, the tissues lining the lungs (pleura), heart (pericardium), and the inner lining of the abdomen (peritoneum) and organs within. It is commonly found with fat wrapping or creeping ...

with pleural and

pericardial effusion A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. The pericardium is a two-part membrane surrounding the heart: the outer fibrous connective membrane and an inner two-layered serous membrane. The two layers of t ...

s are seen in up to 10% of these patients. On the other hand, flares of lupus are uncommon during pregnancy and are often easily treated. The most common symptoms of these flares include arthritis,

rash A rash is a change of the human skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, c ...

es, and fatigue.Systemic Lupus Erythematosus and Pregnancy
at Medscape. Author: Ritu Khurana. Chief Editor: David Chelmow. Updated: Sep 20, 2010 Also, in the

postpartum period The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal perio ...

, there may be exacerbations of lupus due to decreased levels of anti-inflammatory steroids, elevated levels of

and

and progesterone changes. In diagnosing an aggravation of lupus in pregnancy, there need to be a differential diagnosis from lupus-unrelated

complications of pregnancy Complications of pregnancy are health problems that are related to pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal d ...

that may appear in a similar fashion. For example,

chloasma Melasma (also known as chloasma faciei,James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. . or the mask of pregnancy when present in pregnant women) is a tan or dark ...

may appear like the malar rash of lupus,

from

preeclampsia Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease ...

may appear like that of

lupus nephritis Lupus nephritis is an inflammation of the kidneys caused by systemic lupus erythematosus (SLE), an autoimmune disease. It is a type of glomerulonephritis in which the glomeruli become inflamed. Since it is a result of SLE, this type of glomerulo ...

, thrombocytopenia of the

HELLP syndrome HELLP syndrome is a complication of pregnancy; the acronym stands for hemolysis, elevated liver enzymes, and low platelet count. It usually begins during the last three months of pregnancy or shortly after childbirth. Symptoms may include feelin ...

may appear like that of lupus, and pregnancy-related edema of joints can appear like arthritis of lupus.

General preventive measures

Continuing

glucocorticoid Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every verteb ...

s at the lowest effective dose and/or cautious use of

azathioprine Azathioprine (AZA), sold under the brand name Imuran, among others, is an immunosuppressive medication. It is used in rheumatoid arthritis, granulomatosis with polyangiitis, Crohn's disease, ulcerative colitis, and systemic lupus erythematosus, ...

may be preferred in some patients, but needs to be weighed against potential adverse effects of such medications.

References

External links

Systemic Lupus Erythematosus and Pregnancy
at Medscape. Author: Ritu Khurana. Chief Editor: David Chelmow.

{{Pathology of pregnancy, childbirth and the puerperium Health issues in pregnancy Pathology of pregnancy, childbirth and the puerperium