The course of pregnancy in SLE


Authors: D. Tegzová;  K. Andělová 1
Authors‘ workplace: Revmatologický ústav a Revmatologická klinika 1. LF UK v Praze, 1Ústav péče o matku a dítě v Praze
Published in: Čes. Revmatol., 19, 2011, No. 1, p. 17-21.
Category: Reviews

Overview

The course of pregnancy and lactation in patients with SLE is risky. The risk results from the diseases itself, its activity, organ involvement, preconception therapy and the treatment during mother’s pregnancy and lactation. A disease relapse manifesting as skin and joint involvement and leukopenia occurs most often; occurrence of a renal relapse is frequent as well. In the newborns of anti Ro and anti La positive mothers, there is a risk of lupus neonatorum with an irreversible grade III AV block. As a consequence of antiphospholipid syndrome, the risk of reccurent misscarriages is increased. Immunosuppressive therapy of SLE has severe risks considering pregnancy. Low dose glucocorticoids and antimalarials are safe. Azathioprin and cyclosporin A therapy may be considered in same cases, while cyclophosphamide is contraindicated. During treatment with immunosupressants an efficient contraception must be ensured and the drug need to be discontinued in time prior to planned conception. During the cyclophosphamide therapy, it is necessary to preventively ensure protection for the ovum prior to conception to avoid irreversible amenorrhea, preferably with the use of hormonal contraception. Freezing of an embryo is another possibility. Well coordinated therapy has a fundamental significance in monitoring the pregnant patients with SLE in risk. This should be commenced prior to pregnancy with a selection of right contraception and conception planning, when the disease is under control or completely in remission.

Key words:
systemic lupus erythematosus, pregnancy, pharmacotherapy


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Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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