How can lupus affect pregnancy or the newborn? what are the effects of pregnancy on lupus?
Systemic lupus erythematosus is an autoimmune disease with a complex etiopathogenesis, that results from the interaction of multiple genetic, environmental and hormonal factors, leading to inappropriate activation of the immune system.
It is characterized by its clinical polymorphism and its evolution by flares interspersed with periods of remission. It mainly affects young women of childbearing age.
What complications can lupus cause in pregnancy?
Pregnancy during SLE is associated to a high risk of maternal and fetal morbidity and mortality, which requires multidisciplinary management and close collaboration between the patient and her practitioners in order to plan this event and to carry it through the best conditions.
Systemic lupus erythematosus is a multifactorial disorder that usually affects young women, during times of childbearing.
- Premature delivery, especially with a flare-up of lupus.
- Early rupture of the amniotic sac (premature rupture of membranes)
- High blood pressure during pregnancy (preeclampsia)
- Poor fetal growth (restriction of intrauterine growth)
- Stillborn.
- Infection.
- Low platelet count.
Does pregnancy exacerbate SLE?
Pregnancy is a particularly important time for a woman with lupus. It is associated with a high maternal and fetal risk, but specialized and well-coordinated management can reduce these risks.
This period also has a major psychological and emotional dimension which must be taken into account and compelled to prepare medically and humanely. Preconception consultation is fundamental.
It makes it possible to eliminate the absolute contraindications of pregnancy, assess the risks involved, adjust treatments, and educate the patient. A lupus flare can occur at any time during pregnancy and in the postpartum period, mostly when lupus is active during conception.
On the other hand, when lupus has been inactive for at least six months before conception, remission persists in the majority of cases, especially if adequate management is initiated. In some cases, lupus, hitherto unrecognized, can be revealed during pregnancy or postpartum.
Main risk factors for prematurity in a woman without lupus:
- Premature rupture of membranes
- HELLP syndrome
- Trace hydramnios
- Infections
- Premature labor
- Preeclampsia and eclampsia
Main risk factors for prematurity specific to women with SLE:
- Disease activity
- Kidney damage
- High blood pressure
- Corticosteroid therapy
- Antiphospholipid syndrome
- Other factors: disadvantaged socio-economic level, African origin, hypothyroidism, Raynaud's syndrome.
The improved understanding of the factors influencing the course of lupus disease and its specific maternal and fetal complications during pregnancy, as well as therapeutic advances, have currently allowed reasonable hope for a favorable outcome for the mother and for the patient. the child in the majority of cases.
The possibility of serious maternal and / or fetal complications should not be overlooked, however, and the programming of coordinated multidisciplinary monitoring is essential for the successful course of the pregnancy.
This makes it possible to detect early outbreaks of lupus disease as well as maternal-fetal complications and to manage them.
Finally, the experts underline the interest of the dialogue between the various stakeholders, and highlight the need for prospective studies with a well-defined SLE activity and pregnancy results.
Maternal and fetal surveillance:
Surveillance should be multidisciplinary and should include regular clinical, laboratory and ultrasound assessment.
It must be adapted to the obstetric history of the patient and the actual course of the pregnancy.
Generally, monitoring is monthly until the 20th week of amenorrhea, then every 15 days until the 30th week. Then, a weekly visit will make it possible to assess the date of the onset of childbirth.
In conclusion :
Pregnancy in women with SLE should be preceded by a preconception consultation and planned in a remission period of at least 6 months, in order to reduce the risk of Lupus flares and obstetric complications.
The Management of those pregnancies is based on a multidisciplinary approach in specialized centers, with a close collaboration between the different practitioners, and clinical, biological and ultrasound regular monitoring, allowing a therapeutic adjustment, an optimal control of the disease and a successful pregnancy.
References:
Shai R, Quismorio FP, Li L, Kwon OJ, Morrisson J, Wallace DJ Genome-wide screen for systemic lupus erythematosus susceptibility genes in multiplex families. Hum Mol Genet 1999 ; 8 : 639–44.
Wandstrat A, Wakeland E The genetics of complex autoimmune diseases : non-MHC susceptibility genes. Nat Immunol 2001 ; 9 : 802–9.