Systemic Lupus Erythematosus Management in Pregnancy.
fertility
medications
pregnancy
systemic lupus erythematosus
Journal
International journal of women's health
ISSN: 1179-1411
Titre abrégé: Int J Womens Health
Pays: New Zealand
ID NLM: 101531698
Informations de publication
Date de publication:
2022
2022
Historique:
received:
15
11
2021
accepted:
19
01
2022
entrez:
25
2
2022
pubmed:
26
2
2022
medline:
26
2
2022
Statut:
epublish
Résumé
Systemic lupus erythematosus (SLE) affects reproductive aged women. Issues regarding family planning are an important part of SLE patient care. Women with SLE can flare during pregnancy, in particular those who have active disease at conception or prior history of renal disease. These flares can lead to increased adverse pregnancy outcomes including fetal loss, pre-eclampsia, preterm birth and small for gestational aged infants. In addition, women with antiphospholipid antibodies can have thrombosis during pregnancy or higher rates of fetal loss. Women who have anti-Ro/SSA and anti-La/SSB antibodies need special monitoring as their offspring are at risk for congenital complete heart block and neonatal lupus. Ideally, SLE patients should have their disease under good control on medications compatible with pregnancy prior to conception. All patients with SLE should remain on hydroxychloroquine unless contraindicated. We recommend the addition of 81mg/d of aspirin at the end of the first trimester to reduce the risk of pre-eclampsia. The immunosuppressive azathioprine, tacrolimus and cyclosporine are compatible with pregnancy and lactation, mycophenolate mofetil (MMF)/mycophenolic acid are not. Providers should use glucocorticoids at the lowest possible dose. Methotrexate, leflunomide and cyclophosphamide are contraindicated in pregnancy and lactation. SLE patients on the biologics rituximab, belimumab and abatacept can continue these medications until conception and resume during lactation.
Identifiants
pubmed: 35210867
doi: 10.2147/IJWH.S282604
pii: 282604
pmc: PMC8859727
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
199-211Informations de copyright
© 2022 Dao and Bermas.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
Arthritis Rheum. 2010 May;62(5):1494-503
pubmed: 20131283
Int J Rheum Dis. 2020 May;23(5):633-640
pubmed: 32227576
J Womens Health (Larchmt). 2013 Dec;22(12):1023-7
pubmed: 24283710
Clin J Am Soc Nephrol. 2010 Nov;5(11):2060-8
pubmed: 20688887
Matern Child Health J. 2017 Mar;21(3):387-392
pubmed: 28220337
Am J Transplant. 2013 Jun;13(6):1383-9
pubmed: 23617812
Clin Rheumatol. 2016 Jul;35(7):1725-32
pubmed: 27166627
Am J Obstet Gynecol. 2021 Mar;224(3):290.e1-290.e22
pubmed: 32961123
J Perinatol. 2005 Feb;25(2):86-9
pubmed: 15496869
Rheumatology (Oxford). 2011 Sep;50(9):1551-8
pubmed: 21652585
Am J Med. 1986 Aug;81(2):194-200
pubmed: 3740078
Am J Obstet Gynecol. 2008 Aug;199(2):127.e1-6
pubmed: 18456233
Arthritis Care Res (Hoboken). 2020 Apr;72(4):461-488
pubmed: 32090466
Nat Rev Rheumatol. 2013 Nov;9(11):687-94
pubmed: 23838616
Lupus Sci Med. 2014 Jul 15;1(1):e000034
pubmed: 25379194
Transl Res. 2020 Nov;225:70-81
pubmed: 32413497
J Clin Med. 2021 Jun 30;10(13):
pubmed: 34209187
Best Pract Res Clin Rheumatol. 2018 Apr;32(2):188-205
pubmed: 30527426
J Reprod Immunol. 2016 Sep;117:57-65
pubmed: 27474801
Ann Intern Med. 2019 Aug 6;171(3):164-171
pubmed: 31284305
Circ Arrhythm Electrophysiol. 2020 Oct;13(10):e008686
pubmed: 32907357
Ann Rheum Dis. 2018 Feb;77(2):264-269
pubmed: 29092851
J Thromb Haemost. 2006 Feb;4(2):295-306
pubmed: 16420554
Rheumatology (Oxford). 2017 Apr 1;56(4):561-569
pubmed: 28013193
PLoS One. 2014 Aug 13;9(8):e104375
pubmed: 25118692
Lupus. 2002;11(3):175-80
pubmed: 11999882
Curr Opin Immunol. 2012 Dec;24(6):651-7
pubmed: 23131610
J Rheumatol. 1999 Jan;26(1):55-9
pubmed: 9918240
Autoimmune Dis. 2012;2012:301274
pubmed: 22973504
Front Immunol. 2020 Aug 27;11:2084
pubmed: 32973817
Curr Opin Rheumatol. 2018 Mar;30(2):144-150
pubmed: 29251660
Circulation. 2012 Jul 3;126(1):76-82
pubmed: 22626746
J Autoimmun. 2016 Nov;74:6-12
pubmed: 27496151
Arthritis Rheum. 2006 Nov;54(11):3640-7
pubmed: 17075810
Cardiovasc J Afr. 2016 Mar-Apr;27(2):89-94
pubmed: 27213856
Lupus. 2009 Apr;18(4):342-7
pubmed: 19276302
J Pediatr Gastroenterol Nutr. 1986 Mar-Apr;5(2):316-7
pubmed: 2870147
Lupus. 2011 Jul;20(8):829-36
pubmed: 21543513
J Clin Hypertens (Greenwich). 2020 May;22(5):826-834
pubmed: 32338457
Curr Rheumatol Rep. 2021 Feb 10;23(3):16
pubmed: 33569681
Arthritis Rheumatol. 2016 Aug;68(8):1964-9
pubmed: 26990620
Lupus Sci Med. 2016 Jan 12;3(1):e000131
pubmed: 26835148
Teratology. 2000 Dec;62(6):385-92
pubmed: 11091360
Nat Rev Rheumatol. 2015 May;11(5):301-12
pubmed: 25800217
Clin Immunol. 2013 Nov;149(2):211-8
pubmed: 23578823
Ann Intern Med. 2015 Aug 4;163(3):153-63
pubmed: 26098843
Int J Womens Health. 2016 Jul 08;8:265-72
pubmed: 27468250
J Rheumatol. 2005 Sep;32(9):1709-12
pubmed: 16142865
Gastroenterology. 1981 Jan;80(1):72-6
pubmed: 6108894
Semin Arthritis Rheum. 2020 Jun;50(3):451-457
pubmed: 32115237
Arthritis Res Ther. 2007;9(6):R124
pubmed: 18042277
Arthritis Care Res (Hoboken). 2012 May;64(5):668-74
pubmed: 22344961
Arthritis Rheumatol. 2019 Sep;71(9):1400-1412
pubmed: 31385462
Am J Obstet Gynecol. 2005 Oct;193(4):1444-55
pubmed: 16202739
Arthritis Rheum. 2006 Mar;54(3):899-907
pubmed: 16508972
Lupus. 1999;8(1):3-10
pubmed: 10025593
Am J Clin Nutr. 2000 May;71(5 Suppl):1256S-61S
pubmed: 10799399
Am J Obstet Gynecol. 2021 May;224(5):548-549
pubmed: 33434555
Transplantation. 2006 Dec 27;82(12):1698-702
pubmed: 17198262
CMAJ. 2011 Apr 19;183(7):796-804
pubmed: 21482652
Best Pract Res Clin Obstet Gynaecol. 2020 Apr;64:97-106
pubmed: 31866283
Lupus. 2010 Dec;19(14):1665-73
pubmed: 20947541
Am J Obstet Gynecol. 2005 Jun;192(6):1897-904
pubmed: 15970846
Mol Hum Reprod. 2019 Aug 1;25(8):433-444
pubmed: 30953068
Ann Rheum Dis. 2017 Mar;76(3):476-485
pubmed: 27457513
Arthritis Rheumatol. 2020 Apr;72(4):529-556
pubmed: 32090480
Clin Exp Immunol. 2015 Jun;180(3):393-407
pubmed: 25603723
Lupus. 2018 May;27(6):1012-1017
pubmed: 29301469
BJOG. 2001 Nov;108(11):1164-7
pubmed: 11762656
Curr Rheumatol Rep. 2007 May;9(2):101-8
pubmed: 17502039
Arthritis Rheum. 2005 Sep;52(9):2774-82
pubmed: 16142761
Best Pract Res Clin Obstet Gynaecol. 2020 Apr;64:24-30
pubmed: 31677989
Ann Rheum Dis. 2018 Jun;77(6):855-860
pubmed: 29463519
Adv Chronic Kidney Dis. 2013 May;20(3):209-14
pubmed: 23928384