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Systemic Lupus Erthematosus

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Contraception and Pregnancy in Patients with Rheumatic Disease

Abstract

Since systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects women during their reproductive years, pregnancy is a frequently encountered challenge in women with this disorder. In the past, women with SLE were advised to avoid pregnancy because of the fear of harm to the fetus and mother. Fortunately, due to the advances in the management of lupus during pregnancy over the last few decades, many SLE pregnancies have successful maternal and fetal outcomes.

Fertility rates in women with SLE are similar to that of the general population. Studies comparing women with SLE to healthy controls show a similar mean number of pregnancies, between 2.15 and 3.6 (Petri and Allbritton, J Rheumatol. 1993;20(4):650–6). Annually there are about 4,500 pregnancies in women with SLE in the USA (Clowse et al. Am J Obstet Gynecol. 2008;199(2):127 e1–6). The majority will experience no more than mild SLE activity involving the joints and cutaneous disease during pregnancy (Clowse, Rheum Dis Clin North Am. 2007;33(2):237–52). However, for a small number, SLE activity will adversely affect their pregnancies leading to severe SLE exacerbations with organ involvement that may affect long-term maternal survival, or development of preeclampsia, low birth weight, preterm delivery, and/or pregnancy loss. We currently have ways to mitigate this risk by maintaining low SLE activity, choosing appropriate pregnancy timing, monitoring SLE activity by a multidisciplinary team composed of both an obstetrician and a rheumatologist and prompt treatment of any flares. This enables many women with SLE to achieve the delivery of a healthy infant.

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Authors and Affiliations

  1. Division of Rheumatology and Immunology, Duke University Hospital, 3535 Trent Drive, Durham, NC, 27710, USA

    Sara Wasserman M.D. & Megan E. B. Clowse M.D., M.P.H.

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  1. Sara Wasserman M.D.
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  2. Megan E. B. Clowse M.D., M.P.H.
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Correspondence to Megan E. B. Clowse M.D., M.P.H. .

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Editors and Affiliations

  1. Division of Rheumatology, Hospital for Special Surgery Weill Cornell Medical College, New York, New York, USA

    Lisa R. Sammaritano

  2. Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Bonnie L. Bermas

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Wasserman, S., Clowse, M.E.B. (2014). Systemic Lupus Erthematosus. In: Sammaritano, L., Bermas, B. (eds) Contraception and Pregnancy in Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0673-4_4

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  • DOI: https://doi.org/10.1007/978-1-4939-0673-4_4

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