Summary
This article critically analyses the data in the literature on pregnancy in women with systemic lupus erythematosus. Based on the results of recent controlled prospective studies, it is apparent that the long-standing opinion that pregnancy induces exacerbation of the disease should be revised. The presence of active disease and/or a significant loss of renal function at conception are not only associated with a high risk of maternal complications, but also with high frequencies of loss of the fetus, as well as pre- and dysmaturity. Recently, the presence of antiphospholipid antibodies, notably the lupus anticoagulant and anticardiolipin antibodies, has been recognized as being important for the occurrence of death of the fetus, in particular, late in the pregnancy. This is probably due to thrombosis occurring in the placental vessels. However, the results of randomized studies on treatment with antithrombotic drugs and/or procedures lowering, antibody levels must be available before we will know whether the presence of these antibodies should be coupled to specific instructions or not. Although there is a strong association between the neonatal lupus syndrome and the presence of anti-SSA antibodies in maternal blood, the finding of anti-SSA antibodies has up to now had no therapeutic implications. It is concluded that pregnancy in SLE deserves extensive preconceptional counseling and close cooperation between the internist, rheumatologist, obstetrician and the neonatologist.
Similar content being viewed by others
References
Ginzler EM, Diamond HS, Weiren M (1982) A multicenter study of outcome in systemic lupus erythematosus. Arthritis Rheum 25:601–608
Out HJ, Derksen RHWM, Christiaens GCML (1989) Systemic lupus erythematosus and pregnancy. Obstet Gynecol Surv 44:585–591
Garsenstein M, Pollak E, Kark RM (1962) Systemic lupus erythematosus and pregnancy. N Engl J Med 267:165–169
Zulman JI, Talal N, Hoffman GS, Epstein WV (1980) Problems associated with the managment of pregnancies in patients with systemic lupus erythematosus. J Rheumatol 7:37–49
Lockshin MD, Reinits E, Druzin ML, Murrman M, Estes D (1984) Lupus pregnancy. Case-control prospective study demonstrating absence of lupus exacerbations during or after pregnancy. Am J Med 77:893–898
Lockshin MD, Qamar T, Druzin ML (1987) Hazards of lupus pregnancy. J Rheumatol [Suppl 13] 14:214–217
Cohen AS, Reynolds WE, Franklin EC et al (1971) Preliminary criteria for the classification of lupus erythematosus. Bull Rheum Dis 21:643–647
Hayslett JP, Lynn RI (1980) Effect of pregnancy in patients with lupus nephropathy. Kidney Int 18:207–220
Hayslett JP, Reece EA (1985) Systemic lupus erythematosus in pregnancy. Clin Perinatol 12:539–550
Houser MT, Fish AJ, Tagatz GE, Williams PP, Michael AF (1980) Pregnancy and systemic lupus erythematosus. Am J Obstet Gynecol 138:409–413
McGee CD, Makowski EL (1970) Systemic lupus erythematosus in pregnancy. Am J Obstet Gynecol 107:1008–1012
Zurier RB (1975) Systemic lupus erythematosus and pregnancy. Clin Rheum Dis 1:613–620
Fine LG, Barnett EV, Danovitch GM, Nissenson AR, Connolly ME, Lieb SM, Barrett CT (1981) Systemic lupus erythematosus in pregnancy. Ann Intern Med 94:667–677
Meehan RT, Dorsey JK (1987) Pregnancy among patients with systemic lupus erythematosus receiving immunosuppressive therapy. J Rheumatol 14:252–258
Varner MW, Meehan RT, Syrop CH, Strottmann MP, Goplerud CP (1983) Pregnancy in patients with systemic lupus erythematosus. Am J Obstet Gynecol 145:1025–1037
Mintz G, Niz J, Gutierrez G, Garcia-Alonso A, Karchmer S (1986) Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach. J Rheumatol 13:732–739
Estes D, Larson DL (1965) Systemic lupus erythematosus and pregnancy. Clin Obstet Gynecol 8:307–317
Jungers P, Dougados M, Pelissier C, Kuttenn F, Tron F, Lesavre P, Bach JF (1982) Lupus nephropathy and pregnancy. Arch Intern Med 142:771–776
Tozman ECS, Urowitz MB, Gladman DD (1980) Systemic lupus erythematosus and pregnancy. J Rheumatol 7:624–632
Burkett G (1985) Lupus nephropathy and pregnancy. Clin Obstet Gynecol 28:310–323
Hayslett JP (1982) Effect of pregnancy in patients with SLE. Am J Kidney Dis 2:223–234
Imbasciati E, Surina M, Bottino S, Cosci P, Colussi G, Ambroso GC, Massa E, Minetti L, Pardi G, Ponticelli C (1984) Lupus nephropathy and pregnancy. Nephron 36:46–51
Syrop CH, Varner MW (1983) Systemic lupus erythematosus. Clin Obstet Gynecol 26:547–557
Bear RA (1976) Pregnancy in patients with renal disease. A study of 44 cases. Obstet Gynecol 48:13–26
Lockshin MD (1985) Lupus pregnancy. Clin Rheum Dis 11:611–632
Strauch BS, Hayslett JP (1974) Kidney disease and pregnancy. BMJ 4:578–586
Gimovsky ML, Montoro M, Paul RH (1984) Pregnancy outcome in women with systemic lupus erythematosus. Obstet Gynecol 63:686–692
Bear RA (1976) Pregnancy and lupus nephritis: a detailed report of six cases with a review of the literature. Obstet Gynecol 47:715–722
Zurier RB (1980) SLE and motherhood. J Rheumatol 7: 591–599
Lockshin MD, Harpel PC, Druzin ML, Becker CG, Klein RF, Watson RM, Elkon KB, Reinitz E (1985) Lupus pregnancy. II. Unusual pattern of hypocomplementemia and thrombocytopenia in the pregnant patient. Arthritis Rheum 28:58–66
Spargo BH, Lichtig C, Luger AM, Katz AJ, Eindheimer MD (1976) The renal lesion in pre-eclampsia. In: Lindheimer MD, Katz AJ, Zuspan FP (eds) Hypertension in pregnancy. Wiley, New York, pp 129–143
Parazzini F, Acaia B, Ricciardiello O, Fedele L, Uati P, Candiani GB (1988) Short-term reproductive prognosis when no cause can be found for recurrent miscarriage. Br J Obstet Gynaecol 95:654–658
Lindheimer MD, Katz A (1977) Kidney function in pregnancy. Lea and Febiger, Philadelphia, pp 161–180
Derksen RHWM, Kater L (1985) Lupus anticoagulant: revival of an old phenomenon. Clin Exp Rheumatol 3:349–357
Harris EN, Gharavi AE, Hughes GRV (1985) Anti-phospholipid antibodies. Clin Rheum Dis 11:591–609
Triplett DA (1990) Laboratory diagnosis of lupus anticoagulants. Semin Thromb Hemost 16:182–192
Harris EN, Gharavi AE, Boey ML, Patel BM, Mackworthy-Young CG, Loizou S, Hughes GRV (1983) Anticardiolipin antibodies: detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus. Lancet II:1211–1214
Harris EN, Gharavi AE, Patel SP, Hughes GRV (1987) Evaluation of the anticardiolipin antibody test: report of an international workshop held 4 April 1986. Clin Exp Immunol 68:215–222
Nilsson IM, Astedt B, Hedner U, Berezin D (1975) Intrauterine death and circulating anticoagulant (“antithromboplastin”). Acta Med Scand 197:153–159
Derue GJ, Englert HJ, Harris EN, Gharavi AE, Morgan SH, Hull RG, Elder MG, Hawkins DF, Hughes GRV (1985) Fetal loss in systemic lupus: association with anticardiolipin antibodies. J Obstet Gynaecol 5:207–209
Asherson RA, Khamashta MA, Ordi-Ros J, Derksen RHWM, Machin SJ, Barquinero J, Out HJ, Harris EN, Vilardell-Torres M, Hughes GRV (1989) The “primary” antiphospholipid syndrome: major clinical and serological features. Medicine 68:366–374
Derksen RHWM, Hasselaar P, Blokzijl L, Gmelig Meyling FHJ, Groot PhG de (1988) Coagulation screen is more specific than the anticardiolipin antibody ELISA in defining a thrombotic subset of lupus patients. Ann Rheum Dis 47:364–371
Lockshin MD, Druzin ML, Goei S, Qamar T, Magid MS, Jovanovic L, Ferenc M (1985) Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus. N Engl J Med 313:152–156
Scott JR, Rote NS, Branch DW (1987) Immunological aspects of recurrent abortion and fetal death. Obstet Gynecol 70:645–656
Hughes GRV, Harris EN, Gharavi AE (1986) The anticardiolipin syndrome. J Rheumatol 13:486–489
Derksen RHWM, Hasselaar P, Oosting JD, Groot PhG de (1990) The antiphospholipid antibody dilemma. Clin Rheumatol 9 [Suppl 1]:39–44
Branch DW, Dudley DJ, Mitchell MD, Creighton KA, Abbott TM, Hammond EH, Dayne RA (1990) 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 163:210–216
Watson RM, Lane AT, Barnett NK, Bias WB, Arnett FC, Provost TT (1984) Neonatal lupus erythematosus. A clinical, serological and immunogenetic study with review of the literature. Medicine 63:362–378
Maddison PJ (1988) The neonatal lupus syndrome. Clin Exp Rheumatol 6:169–172
Reichlin M (1986) Significance of the Ro antigen system. J Clin Immunol 6:339–345
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Derksen, R.H.W.M. Systemic lupus erythematosus and pregnancy. Rheumatol Int 11, 121–125 (1991). https://doi.org/10.1007/BF00304500
Issue Date:
DOI: https://doi.org/10.1007/BF00304500