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Practical management of pregnancy in systemic lupus erythematosus

Published online by Cambridge University Press:  10 October 2008

Neil MM Buchanan
Lupus Arthritis Research Unit, St Thomas Hospital, London, UK.
Munther Khamashta
Lupus Arthritis Research Unit, St Thomas Hospital, London, UK.
Sian Kerslake
Lupus Arthritis Research Unit, St Thomas Hospital, London, UK.
Beverley J Hunt
Lupus Arthritis Research Unit, St Thomas Hospital, London, UK.
Graham RV Hughes
Lupus Arthritis Research Unit, St Thomas Hospital, London, UK.


Systemic lupus erythematosus (SLE) is a multi-system disorder belonging to the connective tissue group of diseases characterized by circulating non-organ-specific autoantibodies. Its incidence may be increasing and, as milder cases are recognized, it is becoming a condition likely to be encountered in many medical settings. The peak onset is during the child-bearing years when the sex ratio approaches 13:1 in favour of females. Fertility rates are normal and hence pregnancy becomes a common management problem in this group of patients.

Copyright © Cambridge University Press 1993

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1Ballou, SP, Khan, MA, Kushner, I. Clinical features of systemic lupus erythematosus, differences related to race and age of onset. Arthritis Rheum 1982; 25: 5560.CrossRefGoogle ScholarPubMed
2Fries, JF, Holman, HR. Systemic lupus erythematosus, a clinical analysis. In: Smith, LH Jr ed, Major problems in internal medicine. Philadelphia: WB Saunders, 1975: 127131.Google Scholar
3Lockshin, MD, Reinitz, E, Druzin, ML, Murman, M, Estes, D. Lupus pregnancy: case-control study demonstrating absence of lupus exacerbation during and after pregnancy. Am J Med 1984; 77: 893–98.CrossRefGoogle ScholarPubMed
4Lockshin, MD. Pregnancy does not cause systemic lupus erythematosus to worsen. Arthritis Rheum 1989; 32: 665–70.CrossRefGoogle Scholar
5Mintz, G, Rodriguez-Alverez, E. Systemic lupus erythematosus. Rheum Dis Clin North Am 1989; 152: 255–74.Google Scholar
6Petri, M, Howard, D, Repke, J. Frequency of lupus flare in pregnancy: The Hopkins Lupus Pregnancy Center experience. Arthritis Rheum 1991; 34: 1538–45.CrossRefGoogle ScholarPubMed
7Petri, M, Howard, D, Repke, J, Goldman, DW. The Hopkins Lupus Pregnancy Center: 1987–1991 update. Am J Reprod Immunol 1992; 18: 188–91.CrossRefGoogle Scholar
8Hayslett, JP, Lynn, RI. Effect of pregnancy in patients with lupus nephropathy. Kidney Int 1980; 18: 207–20.CrossRefGoogle ScholarPubMed
9Oviasu, E, Hicks, J, Cameron, JS. The outcome of pregnancy in women with lupus nephritis. Lupus 1991; 1: 1925.CrossRefGoogle ScholarPubMed
10Buyon, JP. Systemic lupus erythematosus and the maternal-fetal dyad. Bailliéres Clin Rheumatol 1990; 4: 85103.CrossRefGoogle ScholarPubMed
11Redrow, M, Cherem, LD, Elliot, J, Mangalat, J et al. Dialysis in the management of pregnant patients with renal insufficiency. Medicine 1988; 67: 199208.CrossRefGoogle ScholarPubMed
12Buchanan, NMM, Khamashta, MA, Morton, KE, Kerslake, S et al. A study of 100 high risk lupus pregnancies. Am J Reprod Immunol 1992; 28: 192–94.CrossRefGoogle ScholarPubMed
13Blandford, AT, Murphy, BEP. In vitro metabolism of prednisolone, dexamethasone, betamethasone and cortisol by the human placenta. Am J Obstet Gynecol 1977; 127: 264–67.CrossRefGoogle Scholar
14Parke, AL. Antimalarial drugs and pregnancy in systemic lupus erythematosus and pregnancy. J Rheum 1988; 15: 607–10.Google Scholar
15Ostensen, M. Treatment with immunosuppressive and disease modifying drugs during pregnancy and lactation. Am J Reprod Immunol 1992; 28: 148–52.CrossRefGoogle ScholarPubMed
16Butters, L, Kennedy, S, Rubin, PC. Atenolol in essential hypertension during pregnancy. Br Med J 1990; 301: 587–89.CrossRefGoogle ScholarPubMed
17Constantine, G, Beavers, DG, Reynolds, AL, Luesley, DM. Nifedipine as a second line antihypertensive drug in pregnancy. Br J Obstet Gynaecol 1987; 94: 1136–42.CrossRefGoogle ScholarPubMed
18McCune, AB, Weston, WL, Lee, LA. Maternal and fetal outcome in neonatal lupus erythematosus. Ann Int Med 1987; 106: 518–23.CrossRefGoogle ScholarPubMed
19Franco, HL, Weston, WL, Tan, EM. Association of antibodies to Sicca Syndrome antigens in newborns with lupus erythematosus and their mothers. Clin Res 1980; 28: 134A (abstract).Google Scholar
20Provost, TT, Watson, R, Gammon, WR et al. The neonatal lupus syndrome associated with UIRNP (nRNP) antibodies. N Engl J Med 1987; 315: 1135–38.CrossRefGoogle Scholar
21Lockshin, MD, Bonfa, E, Elkon, K, Druzin, ML. Neonatal lupus risk to newborns of mothers with systemic lupus erythematosus. Arthritis Rheum 1988; 31: 697701.CrossRefGoogle ScholarPubMed
22Lee, LA. The neonatal lupus syndrome. Bailliéres Clin Rheumatol 1990; 4: 6984.CrossRefGoogle ScholarPubMed
23Lee, LA, Bias, WB, Arnett, FC, Huff, C et al. Immunogenetics of the neonatal lupus syndrome. Ann Intern Med 1983; 99: 592–96.CrossRefGoogle ScholarPubMed
24Gawkrodger, DJ, Beveridge, GW. Neonatal lupus erythematosus in four successive siblings born to a mother with discoid lupus erythematosus. Br J Dermatol 1984; 111: 683–87.CrossRefGoogle ScholarPubMed
25Stiehm, ER. Fetal defense mechanisms. Am J Dis Child 1975; 129: 483–92.Google ScholarPubMed
26Buyon, JP, Swersky, S, Fox, H, Bierman, F et al. Intrauterine theraphy for presumptive fetal myocarditis with acquired heart block due to systemic lupus erythematosus. Arthritis Rheum 1987; 30: 4449.CrossRefGoogle Scholar
27Branch, DW, Scott, JR. Clinical implications of antiphospholipid antibodies: the Utah experience. In: Harris, EN, Exner, T, Hughes, GRV, Asherson, RA eds, Phospholipid-binding antibodies. Boca Raton: CRC Press, 1991; 335–46.Google Scholar
28Harris, EN. Maternal antibodies and pregnancy: the antiphospholipid antibody syndrome. Bailliéres Clin Rheumatol 1990; 4: 5368.CrossRefGoogle ScholarPubMed
29Triplett, DA. Antiphospholipid antibodies and recurrent pregnancy loss. Am J Reprod Immunol 1989; 20: 5267.CrossRefGoogle ScholarPubMed
30Lockshin, MD, Qamar, T, Levy, RA. Anticardiolipin and related antibodies: thrombodies and fetal death. In: Scott, JS, Bird, HA eds. Pregnancy, autoimmunity and connective tissue disorders. New York: Oxford University Press, 1990; 185211.Google Scholar
31Hughes, GRV. Thrombosis, abortion, cerebral disease and the lupus anticoagulant. Br Med J 1983; 287: 1088–89.CrossRefGoogle ScholarPubMed
32Harris, EN, Chan, JKH, Asherson, RA, Aber, VR, Gharavi, AE, Hughes, GRV. Thrombosis, recurrent fetal loss and thrombocytopenia. Arch Intern Med 1986; 146: 2153–56.CrossRefGoogle ScholarPubMed
33Love, PE, Santoro, SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Ann Intern Med 1990; 112: 682–98.CrossRefGoogle ScholarPubMed
34Hughes, GRV. The antiphospholipid syndrome- ten years on. Lancet 1993; 342: 341–44.CrossRefGoogle Scholar
35Harris, EN. Syndrome of the black swan. Br J Rheumatol 1989; 26: 324–26.CrossRefGoogle Scholar
36Vianna, JL, Khamashta, MA, Ordi-Ros, J et al. Comparision of the primary and secondary antiphospholipid syndrome. A European multicentre study of 114 patients. Am J Med 1993 (in press).Google Scholar
37Out, HJ, Bruinse, HW, Christiaens, GCML et al. A prospective, controlled study on obstetric risks of pregnant women with antiphospholipid antibodies. Am J Obstet Gynecol 1992; 167: 2632.CrossRefGoogle ScholarPubMed
38Branch, DW, Scott, JR, Kochenour, NK, Hershgold, E. Obstetric complications associated with the lupus anticoagulant. N Engl J Med 1985; 313: 1322–26.CrossRefGoogle ScholarPubMed
39Lockshin, MD, Wamar, R, Druzin, ML, Goei, S. Antibody to cardiolipin, lupus anticoagulant, and fetal death. J Rheumatol 1987; 14: 259–62.Google ScholarPubMed
40Out, H, Kooijman, CD, Bruinse, HW, Derksen, RHWM. Histopathological findings in placentae from patients with intrauterine fetal death and antiphospholipid antibodies. J Obstet Gynecol Reprod Biol 1991; 41: 179–86.CrossRefGoogle Scholar
41Kerslake, S, Morton, KE, Versi, E et al. Early Doppler studies in lupus pregnancy. Am J Reprod Immunol 1992; 28: 172–75.CrossRefGoogle ScholarPubMed
42Trudinger, BJ, Stewart, GJ, Cook, CM, Connelly, A, Exner, T. Monitoring lupus anticoagulant - positive pregnancies with umbilical artery flow velocity waveforms. Obstet Gynecol 1988; 72: 215–18.Google ScholarPubMed
43de Vries, TW, van der Veer, E, Heijmans, HSA. Warfarin embryopathy: patient, possibility, pathogenesis and prognosis. Br J Obstet Gynaecol 1993; 100: 869–71.CrossRefGoogle ScholarPubMed
44Lockshin, MD, Druzin, ML, Qamar, T. Prednisolone does not prevent recurrent fetal death in women with antiphospholipid antibody. Am J Obstet Gynecol 1989; 160: 439–43.CrossRefGoogle Scholar
45Cowchock, FS, Reece, EA, Balaban, D, Branch, DW, Plouffe, L. Repeated fetal losses associated with antiphospholipid antibodies. A collaborative randomized trial comparing prednisolone with low-dose heparin treatment. Am J Obstet Gynecol 1992; 166: 1318–23.CrossRefGoogle Scholar
46Carreras, LD, Vermylen, JG. Lupus anticoagulant and thrombosis - possible role of inhibition of prostacyclin formation. Thromb Haemost 1982; 48: 3840.Google ScholarPubMed
47Kaaja, R, Julkunen, H, Viinikka, L, Ylikorkala, O. Production of prostacyclin and thromboxane in lupus pregnancies. Effect of small dose of aspirin. Obstet Gynecol 1993; 81: 327–31.Google ScholarPubMed
48Branch, DW, Dudley, DJ, Mitchell, MD et al. Immunoglobulin G fractions from patients with antiphospholipid antibodies cause fetal death in BALB/C mice: a model for autoimmune fetal loss. Am J Obstet Gynecol 1990; 163: 210–16.CrossRefGoogle ScholarPubMed
49Blank, M, Cotien, J, Toder, V, Shoenfeld, Y. Induction of antiphospholipid syndrome in naive mice with mouse lupus monoclonal and human polyclonal anticardiolipin antibodies. Proc Natl Acad Sci 1992; 88: 3069–73.CrossRefGoogle Scholar
50Fishman, P, Falach-Vaknine, E, Zigelman, R et al. Prevention of fetal loss in experimental antiphospholipid syndrome by in vivo administration of recombinant interleukin-3. J Clin Invest 1993; 91: 1834–37.CrossRefGoogle ScholarPubMed

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