Lupus and pregnancy

Did You Know?

• Women with lupus who receive kidney transplants have pregnancy outcomes similar to transplant recipients without lupus.
• Women with anti-Ro or anti-La antibodies often have echocardiograms between the 16th and 30th weeks of pregnancy to monitor heart health.
• Continuing glucocorticoids at the lowest effective dose or cautious use of azathioprine may be preferred in some patients.

Miscarriage

Lupus increases the rate of fetal death in utero and spontaneous abortion. The overall live-birth rate is estimated at 72%. First-trimester miscarriages may have no known cause or be linked to active lupus, while later losses are primarily due to antiphospholipid syndrome despite heparin and aspirin treatment. All women with lupus are recommended to be screened for antiphospholipid antibodies, including lupus anticoagulant and anticardiolipin antibodies.

Neonatal lupus

When a mother has lupus, her newborn may develop neonatal lupus, often seen as a rash similar to discoid lupus, and occasionally more serious issues like heart block or an enlarged spleen and liver. This condition is typically mild and resolves on its own. Identifying high-risk mothers enables early treatment before or after birth.

Aggravation of lupus

Aggravation of lupus occurs in about 20-30% of pregnancies in women with lupus. Increased disease activity is expected due to elevated estrogen, prolactin, and certain cytokines. A long remission before pregnancy reduces risk: 7-33% in women in remission for at least 6 months, versus 61-67% in those with active lupus at conception. Renal disease flare-up is the most common presentation, seen equally in US and European populations. Serositis with pleural and pericardial effusions occurs in up to 10% of these patients. Flares are uncommon and often easily treated, with symptoms including arthritis, rashes, and fatigue. In the postpartum period, exacerbations may occur due to decreased anti-inflammatory steroids and elevated prolactin and estrogen/progesterone changes. Diagnosis requires differentiating from lupus-unrelated complications: chloasma may mimic malar rash, proteinuria from preeclampsia may mimic lupus nephritis, thrombocytopenia of HELLP syndrome may mimic lupus, and pregnancy-related joint edema may mimic arthritis.