gynecology and obstetrics
Autoimmune Disorders in Pregnancy
Systemic Lupus Erythematosus in Pregnancy
 Systemic Lupus Erythematosus (SLE) may first appear during pregnancy; women who have had an unexplained 2nd-trimester stillbirth, a fetus with growth restriction, preterm delivery, or recurrent spontaneous abortions may later be diagnosed with SLE. The course of preexisting SLE during pregnancy cannot be predicted, but SLE may worsen, particularly immediately postpartum. Outcomes are better if conception can be delayed until the disorder has been inactive for at least 6 months, the drug regimen has been adjusted in advance, and blood pressure and renal function are normal. Complications may include ( Reference ) Small-for-Gestational-Age (SGA) Infant None Preterm delivery due to Preeclampsia and Eclampsia None Congenital heart block due to maternal antibodies that cross the placenta Significant preexisting renal or cardiac complications increase risk of maternal morbidity and mortality. Diffuse nephritis, hypertension, or the presence of circulating antiphospholipid antibodies (usually anticardiolipin antibody or lupus anticoagulant) increases risk of perinatal mortality. Neonates may have anemia, thrombocytopenia, or leukopenia; these disorders tend to resolve during the first weeks after birth when maternal antibodies disappear. Ifhydroxychloroquinewas used before conception, it may be continued throughout pregnancy. SLE flares are usually treated with low-doseprednisone, IV pulsemethylprednisolone,hydroxychloroquine, and/orazathioprine. High-doseprednisoneandcyclophosphamideincrease obstetric risks and are thus reserved for severe lupus complications. 1.Clowse ME, Jamison M, Myers E, James AH: A national study of the complications of lupus in pregnancy.Am J Obstet Gynecol199(2):127.e1-127.e1276, 2008. doi:10.1016/j.ajog.2008.03.012 