Management of systemic lupus erythematosus during pregnancy: challenges and solutions

Caroline L Knight, Catherine Nelson-Piercy Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, St Thomas’ Hospital, London, UK Abstract: Systemic lupus erythematosus (SLE) is a chroni...

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Autores principales:	Knight CL, Nelson-Piercy C
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	systemic lupus erythematosus conception counselling dication nagement of pregnancy pregnancy complications neonatal lupus Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/522714c29ada4c21811c5402d6a2a3e5
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spelling	oai:doaj.org-article:522714c29ada4c21811c5402d6a2a3e52021-12-02T00:16:45ZManagement of systemic lupus erythematosus during pregnancy: challenges and solutions1179-156Xhttps://doaj.org/article/522714c29ada4c21811c5402d6a2a3e52017-03-01T00:00:00Zhttps://www.dovepress.com/management-of-systemic-lupus-erythematosus-during-pregnancy-challenges-peer-reviewed-article-OARRRhttps://doaj.org/toc/1179-156XCaroline L Knight, Catherine Nelson-Piercy Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, St Thomas’ Hospital, London, UK Abstract: Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease predominantly affecting women, particularly those of childbearing age. SLE provides challenges in the prepregnancy, antenatal, intrapartum, and postpartum periods for these women, and for the medical, obstetric, and midwifery teams who provide their care. As with many medical conditions in pregnancy, the best maternal and fetal–neonatal outcomes are obtained with a planned pregnancy and a cohesive multidisciplinary approach. Effective prepregnancy risk assessment and counseling includes exploration of factors for poor pregnancy outcome, discussion of risks, and appropriate planning for pregnancy, with consideration of discussion of relative contraindications to pregnancy. In pregnancy, early referral for hospital-coordinated care, involvement of obstetricians and rheumatologists (and other specialists as required), an individual management plan, regular reviews, and early recognition of flares and complications are all important. Women are at risk of lupus flares, worsening renal impairment, onset of or worsening hypertension, preeclampsia, and/or venous thromboembolism, and miscarriage, intrauterine growth restriction, preterm delivery, and/or neonatal lupus syndrome (congenital heart block or neonatal lupus erythematosus). A cesarean section may be required in certain obstetric contexts (such as urgent preterm delivery for maternal and/or fetal well-being), but vaginal birth should be the aim for the majority of women. Postnatally, an ongoing individual management plan remains important, with neonatal management where necessary and rheumatology follow-up. This article explores the challenges at each stage of pregnancy, discusses the effect of SLE on pregnancy and vice versa, and reviews antirheumatic medications with the latest guidance about their use and safety in pregnancy. Such information is required to effectively and safely manage each stage of pregnancy in women with SLE. Keywords: systemic lupus erythematosus, preconception counseling, medication, management of pregnancy, pregnancy complications, neonatal lupusKnight CLNelson-Piercy CDove Medical Pressarticlesystemic lupus erythematosusconception counsellingdicationnagement of pregnancypregnancy complicationsneonatal lupusDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol Volume 9, Pp 37-53 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	systemic lupus erythematosus conception counselling dication nagement of pregnancy pregnancy complications neonatal lupus Diseases of the musculoskeletal system RC925-935
spellingShingle	systemic lupus erythematosus conception counselling dication nagement of pregnancy pregnancy complications neonatal lupus Diseases of the musculoskeletal system RC925-935 Knight CL Nelson-Piercy C Management of systemic lupus erythematosus during pregnancy: challenges and solutions
description	Caroline L Knight, Catherine Nelson-Piercy Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, St Thomas’ Hospital, London, UK Abstract: Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease predominantly affecting women, particularly those of childbearing age. SLE provides challenges in the prepregnancy, antenatal, intrapartum, and postpartum periods for these women, and for the medical, obstetric, and midwifery teams who provide their care. As with many medical conditions in pregnancy, the best maternal and fetal–neonatal outcomes are obtained with a planned pregnancy and a cohesive multidisciplinary approach. Effective prepregnancy risk assessment and counseling includes exploration of factors for poor pregnancy outcome, discussion of risks, and appropriate planning for pregnancy, with consideration of discussion of relative contraindications to pregnancy. In pregnancy, early referral for hospital-coordinated care, involvement of obstetricians and rheumatologists (and other specialists as required), an individual management plan, regular reviews, and early recognition of flares and complications are all important. Women are at risk of lupus flares, worsening renal impairment, onset of or worsening hypertension, preeclampsia, and/or venous thromboembolism, and miscarriage, intrauterine growth restriction, preterm delivery, and/or neonatal lupus syndrome (congenital heart block or neonatal lupus erythematosus). A cesarean section may be required in certain obstetric contexts (such as urgent preterm delivery for maternal and/or fetal well-being), but vaginal birth should be the aim for the majority of women. Postnatally, an ongoing individual management plan remains important, with neonatal management where necessary and rheumatology follow-up. This article explores the challenges at each stage of pregnancy, discusses the effect of SLE on pregnancy and vice versa, and reviews antirheumatic medications with the latest guidance about their use and safety in pregnancy. Such information is required to effectively and safely manage each stage of pregnancy in women with SLE. Keywords: systemic lupus erythematosus, preconception counseling, medication, management of pregnancy, pregnancy complications, neonatal lupus
format	article
author	Knight CL Nelson-Piercy C
author_facet	Knight CL Nelson-Piercy C
author_sort	Knight CL
title	Management of systemic lupus erythematosus during pregnancy: challenges and solutions
title_short	Management of systemic lupus erythematosus during pregnancy: challenges and solutions
title_full	Management of systemic lupus erythematosus during pregnancy: challenges and solutions
title_fullStr	Management of systemic lupus erythematosus during pregnancy: challenges and solutions
title_full_unstemmed	Management of systemic lupus erythematosus during pregnancy: challenges and solutions
title_sort	management of systemic lupus erythematosus during pregnancy: challenges and solutions
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/522714c29ada4c21811c5402d6a2a3e5
work_keys_str_mv	AT knightcl managementofsystemiclupuserythematosusduringpregnancychallengesandsolutions AT nelsonpiercyc managementofsystemiclupuserythematosusduringpregnancychallengesandsolutions
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Management of systemic lupus erythematosus during pregnancy: challenges and solutions

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