Systemic Lupus Erythematosus/Antiphospholipid Syndrome and Pregnancy

Journal/Book: Z Rheumatol 1998; 57 Suppl. 1: 8 (V 15). 1998;

Abstract: Lupus Unit St. Thomas' Hospital London Lupus activity during pregnancy has been the subject of much research and debate recently. Two out of three women with SLE flare during pregnancy. SLE may flare during any trimester of pregnancy as well as in the puerperium; however flares are usually mild affecting skin and joints and unless affecting the kidney do not confer any adverse prognosis on pregnancy outcome. Diagnosis of SLE flare can be difficult during pregnancy and must rely on thorough clinical and laboratory assessment. No data support the thesis that corticosteroids prevent SLE flares during pregnancy and therefore prophylactic prednisone should not be given routinely. SLE flares can be treated depending on severity with NSAIDs or with hydroxychloroquine prednisone or azathioprine. Antiphospholipid antibodies are of important clinical significance because of their association with thrombosis both arterial and venous and recurrent pregnancy loss - the antiphospholipid (Hughes) syndrome. Pregnant patients with antiphospholipid syndrome may suffer from recurrent pregnancy loss pre-eclampsia intrauterine growth restriction and placental abruption. The mechanisms underlying these adverse pregnancy outcomes have not yet been established. The management of pregnancy in women known to have antiphospholipid syndrome is the subject of much debate and as yet there have been very few randomized controlled trials. Anticoagulation in one form or another is the preferred treatment rather than steroids (once widely recommended). The current choices lie between aspirin heparin or both. le

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