Lupus and pregnancy

Lupus and pregnancy can present some particular challenges for both mother and child. While most infants born to mothers who have lupus are healthy, mothers with lupus as a pre-existing disease in pregnancy should remain under medical care until delivery. In general, women with lupus and, in addition, hypertension, proteinuria, and azotemia have an extra increased risk for pregnancy complications, including miscarriage, stillbirth, pre-eclampsia, preterm birth, and intrauterine growth restriction. Pregnancy outcomes in women with lupus who receive kidney transplants are similar to those of transplant recipients without lupus. Women pregnant and known to have anti-Ro (SSA) or anti-La antibodies (SSB) often have echocardiograms during the 16th and 30th weeks of pregnancy to monitor the health of the heart and surrounding vasculature. Contraception and other reliable forms of pregnancy prevention is routinely advised for women with lupus, since getting pregnant during active disease was found to be harmful. Lupus nephritis was the most common manifestation. Of live births, approximately one third are delivered prematurely. Lupus causes an increased rate of fetal death in utero and spontaneous abortion (miscarriage). The overall live-birth rate in somebody with lupus has been estimated to be 72%. Pregnancy outcome appears to be worse in those with lupus whose disease flares up during pregnancy. Miscarriages in the first trimester appear either to have no known cause or to be associated with signs of active lupus. Later losses appear to occur primarily due to the antiphospholipid syndrome, in spite of treatment with heparin and aspirin. All women with lupus, even those without previous history of miscarriage, are recommended to be screened for antiphospholipid antibodies, both the lupus anticoagulant (the RVVT and sensitive PTT are the best screening battery) and anticardiolipin antibodies. Neonatal lupus is the occurrence of lupus symptoms in an infant born from a mother with lupus, most commonly presenting with a rash resembling discoid lupus erythematosus, and sometimes with systemic abnormalities such as heart block or hepatosplenomegaly.