Pregnancy and Rheumatic Diseases

M. Gayed; C. Gordon

Disclosures

Rheumatology. 2007;46(11):1634-1640. 

In This Article

Fetal Outcome

Fetal Loss

Pregnancies in SLE patients are associated with a greater risk of still births, abortions and premature delivery than in the general population.[15,51] The risk is increased in women who have previously experienced fetal loss, active renal disease at conception, maternal hypertension and the presence of anti-phospholipid antibodies. Recurrent fetal loss is also one of the criteria when diagnosing APS and the presence of both lupus anticoagulant and anticardiolipin antibodies is associated with the highest risk of fetal loss.

Intrauterine Growth Restriction

The risk of IUGR is increased in pregnancies with a maternal diagnosis of SLE and APS despite adjustment for maternal ethnicity.[21] In SLE patients, hypertension, active lupus and APS are significant predictive factors for IUGR.[14,50,52,53] Fetal loss in early pregnancy in APS can be due to failure of the placenta to implant, due to the effect of anti-phospholipid antibodies on anionic phospholipids and the effect of B2-glycoprotein on trophoblasts. Thrombosis in APS is also thought to have a role in pregnancy loss due to uteroplacental insufficiency from multiple placental thromboses and infarcts.[31] A good predictor of adverse pregnancy outcome is doppler ultrasound examination during the second trimester. An abnormal uterine artery wave form has been shown to be a predictor of fetal or neonatal death.[54] The use of aspirin and heparin in pregnancy probably reduces miscarriages by an antithrombotic mechanism, as well as by preventing pathological apoptosis and anti-complement effects.[55]

Premature Delivery

Premature delivery is common in patients with lupus, vasculitis, systemic sclerosis and especially antiphospholipid syndrome.[26,45,46,52,56] Premature delivery has been found to occur in up to 55% of SLE and vasculitis pregnancies. Fetal outcome, in terms of IUGR, prematurity and fetal loss were more favourable in patient with a past history of lupus nephritis if the patients renal function is normal, blood pressure is controlled and there is no significant proteinuria at conception.

There are several complications of prematurity, regardless of underlying cause, such as breathing difficulties, infection, jaundice, feeding difficulties, developmental abnormalities and neonatal death. Breathing difficulties are usually due to insufficient surfactant, which can be reduced by a 48-h course of dexamethsone or betamethasone in cases where there is a high chance of premature delivery, such as active maternal disease or fetal distress. Although prematurity and neonatal problems are common in children born to women with APS, the long-term childhood course has been found to be similar to that of other premature infants.[57] It has also been found that the children born to mothers with lupus, have a similar incidence of minor physical abnormalities as that of the general population in a small US study.[58]

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