Pregnancy in Patients with SLE

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease predominantly affecting women of childbearing age. Pregnancy in women with SLE is associated with higher fetal and maternal risk compared with the general population. SLE flares, higher rates of pregnancy complications and the risk of Neonatal Lupus Syndromes (NLS), especially congenital Complete Heart Block (CHB) are major concerns. Pregnancy complications include fetal loss, preeclampsia, preterm delivery and IntraUterine Growth Restriction (IUGR). High disease activity, renal involvement and the presence of antiphospholipid (aPL) antibodies, anti-SSA/Ro and SSB/La specific antibodies are particularly at risk. As normal physiological changes during pregnancy could show symptoms and signs resembling those with active SLE, it is sometimes difficult to distinguish between these conditions. One of the candidate clinical markers would be high titer of antidouble-stranded DNA antibodies to distinguish between flare of SLE and normal physiological changes during pregnancy. Medications during pregnancy are also an important issue. Some immune-suppressants such as cyclophosphamide or Mycophenolate Mofetil (MMF) should not be taken during pregnancy. Non-fluorinated steroids, calcineurin inhibitors and azathioprine can be used and continuous use of hydroxy chloroquine during pregnancy is considered beneficial. Administration of low-dose aspirin prior to 16 weeks of gestation should be considered in all pregnant women with SLE at elevated risk of preeclampsia. In conclusion, it is important that disease progression and development of auto antibodies be monitored in pregnant women at risk of SLE in order to ensure good outcomes.