Rheumatology International

, Volume 11, Issue 3, pp 121–125 | Cite as

Systemic lupus erythematosus and pregnancy

  • R. H. W. M. Derksen
Clinical Aspects

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.

Key words

Systemic lupus erythematosus Pregnancy Antiphospholipid antibodies Neonatal lupus 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ginzler EM, Diamond HS, Weiren M (1982) A multicenter study of outcome in systemic lupus erythematosus. Arthritis Rheum 25:601–608Google Scholar
  2. 2.
    Out HJ, Derksen RHWM, Christiaens GCML (1989) Systemic lupus erythematosus and pregnancy. Obstet Gynecol Surv 44:585–591Google Scholar
  3. 3.
    Garsenstein M, Pollak E, Kark RM (1962) Systemic lupus erythematosus and pregnancy. N Engl J Med 267:165–169Google Scholar
  4. 4.
    Zulman JI, Talal N, Hoffman GS, Epstein WV (1980) Problems associated with the managment of pregnancies in patients with systemic lupus erythematosus. J Rheumatol 7:37–49Google Scholar
  5. 5.
    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 77:893–898Google Scholar
  6. 6.
    Lockshin MD, Qamar T, Druzin ML (1987) Hazards of lupus pregnancy. J Rheumatol [Suppl 13] 14:214–217Google Scholar
  7. 7.
    Cohen AS, Reynolds WE, Franklin EC et al (1971) Preliminary criteria for the classification of lupus erythematosus. Bull Rheum Dis 21:643–647Google Scholar
  8. 8.
    Hayslett JP, Lynn RI (1980) Effect of pregnancy in patients with lupus nephropathy. Kidney Int 18:207–220Google Scholar
  9. 9.
    Hayslett JP, Reece EA (1985) Systemic lupus erythematosus in pregnancy. Clin Perinatol 12:539–550Google Scholar
  10. 10.
    Houser MT, Fish AJ, Tagatz GE, Williams PP, Michael AF (1980) Pregnancy and systemic lupus erythematosus. Am J Obstet Gynecol 138:409–413Google Scholar
  11. 11.
    McGee CD, Makowski EL (1970) Systemic lupus erythematosus in pregnancy. Am J Obstet Gynecol 107:1008–1012Google Scholar
  12. 12.
    Zurier RB (1975) Systemic lupus erythematosus and pregnancy. Clin Rheum Dis 1:613–620Google Scholar
  13. 13.
    Fine LG, Barnett EV, Danovitch GM, Nissenson AR, Connolly ME, Lieb SM, Barrett CT (1981) Systemic lupus erythematosus in pregnancy. Ann Intern Med 94:667–677Google Scholar
  14. 14.
    Meehan RT, Dorsey JK (1987) Pregnancy among patients with systemic lupus erythematosus receiving immunosuppressive therapy. J Rheumatol 14:252–258Google Scholar
  15. 15.
    Varner MW, Meehan RT, Syrop CH, Strottmann MP, Goplerud CP (1983) Pregnancy in patients with systemic lupus erythematosus. Am J Obstet Gynecol 145:1025–1037Google Scholar
  16. 16.
    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 13:732–739Google Scholar
  17. 17.
    Estes D, Larson DL (1965) Systemic lupus erythematosus and pregnancy. Clin Obstet Gynecol 8:307–317Google Scholar
  18. 18.
    Jungers P, Dougados M, Pelissier C, Kuttenn F, Tron F, Lesavre P, Bach JF (1982) Lupus nephropathy and pregnancy. Arch Intern Med 142:771–776Google Scholar
  19. 19.
    Tozman ECS, Urowitz MB, Gladman DD (1980) Systemic lupus erythematosus and pregnancy. J Rheumatol 7:624–632Google Scholar
  20. 20.
    Burkett G (1985) Lupus nephropathy and pregnancy. Clin Obstet Gynecol 28:310–323Google Scholar
  21. 21.
    Hayslett JP (1982) Effect of pregnancy in patients with SLE. Am J Kidney Dis 2:223–234Google Scholar
  22. 22.
    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 36:46–51Google Scholar
  23. 23.
    Syrop CH, Varner MW (1983) Systemic lupus erythematosus. Clin Obstet Gynecol 26:547–557Google Scholar
  24. 24.
    Bear RA (1976) Pregnancy in patients with renal disease. A study of 44 cases. Obstet Gynecol 48:13–26Google Scholar
  25. 25.
    Lockshin MD (1985) Lupus pregnancy. Clin Rheum Dis 11:611–632Google Scholar
  26. 26.
    Strauch BS, Hayslett JP (1974) Kidney disease and pregnancy. BMJ 4:578–586Google Scholar
  27. 27.
    Gimovsky ML, Montoro M, Paul RH (1984) Pregnancy outcome in women with systemic lupus erythematosus. Obstet Gynecol 63:686–692Google Scholar
  28. 28.
    Bear RA (1976) Pregnancy and lupus nephritis: a detailed report of six cases with a review of the literature. Obstet Gynecol 47:715–722Google Scholar
  29. 29.
    Zurier RB (1980) SLE and motherhood. J Rheumatol 7: 591–599Google Scholar
  30. 30.
    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 28:58–66Google Scholar
  31. 31.
    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 129–143Google Scholar
  32. 32.
    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 95:654–658Google Scholar
  33. 33.
    Lindheimer MD, Katz A (1977) Kidney function in pregnancy. Lea and Febiger, Philadelphia, pp 161–180Google Scholar
  34. 34.
    Derksen RHWM, Kater L (1985) Lupus anticoagulant: revival of an old phenomenon. Clin Exp Rheumatol 3:349–357Google Scholar
  35. 35.
    Harris EN, Gharavi AE, Hughes GRV (1985) Anti-phospholipid antibodies. Clin Rheum Dis 11:591–609Google Scholar
  36. 36.
    Triplett DA (1990) Laboratory diagnosis of lupus anticoagulants. Semin Thromb Hemost 16:182–192Google Scholar
  37. 37.
    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:1211–1214Google Scholar
  38. 38.
    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 68:215–222Google Scholar
  39. 39.
    Nilsson IM, Astedt B, Hedner U, Berezin D (1975) Intrauterine death and circulating anticoagulant (“antithromboplastin”). Acta Med Scand 197:153–159Google Scholar
  40. 40.
    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 5:207–209Google Scholar
  41. 41.
    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 68:366–374Google Scholar
  42. 42.
    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 47:364–371Google Scholar
  43. 43.
    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 313:152–156Google Scholar
  44. 44.
    Scott JR, Rote NS, Branch DW (1987) Immunological aspects of recurrent abortion and fetal death. Obstet Gynecol 70:645–656Google Scholar
  45. 45.
    Hughes GRV, Harris EN, Gharavi AE (1986) The anticardiolipin syndrome. J Rheumatol 13:486–489Google Scholar
  46. 46.
    Derksen RHWM, Hasselaar P, Oosting JD, Groot PhG de (1990) The antiphospholipid antibody dilemma. Clin Rheumatol 9 [Suppl 1]:39–44Google Scholar
  47. 47.
    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 163:210–216Google Scholar
  48. 48.
    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 63:362–378Google Scholar
  49. 49.
    Maddison PJ (1988) The neonatal lupus syndrome. Clin Exp Rheumatol 6:169–172Google Scholar
  50. 50.
    Reichlin M (1986) Significance of the Ro antigen system. J Clin Immunol 6:339–345Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • R. H. W. M. Derksen
    • 1
  1. 1.Department of Internal Medicine, Division of ImmunopathologyUniversity Hospital UtrechtUtrechtThe Netherlands

Personalised recommendations