Lupus patients want to get pregnant?

Can patients with systemic lupus erythematosus become pregnant? Pay attention to the following points! Systemic lupus erythematosus (SLE) is a systemic autoimmune disease.
The main clinical features are multi-system and multi-organ involvement, repeated recurrence and remission, and the presence of a large number of autoantibodies in the body.
If not treated in time, it will cause affected organs.
Irreversible damage to the organ will eventually lead to the death of the patient.

SLE occurs in women of childbearing age between 20 and 40 years old.
The two-way influence between SLE and pregnancy makes pregnancy a difficult and very important clinical problem for SLE patients.

Xiaojie will introduce from the following four aspects.

 1.
The impact of pregnancy on maternal SLE and fetus (1) Lupus can increase the risk of multiple diseases during pregnancy.
According to the national data of Italy from 2000 to 2003, the mortality rate of pregnant women with SLE increased by nearly 20 times.
However, in 2008, the Department of Obstetrics and Gynecology in the United States National data show that the mortality rate of pregnant women with SLE is 0.
3%, which is the same as that of non-pregnant SLE patients during the same period.

However, the risk of thrombosis, infection, thrombocytopenia, and blood transfusion in SLE pregnant women increased by 3 to 7 times; the rate of cesarean section increased by 1.
7 times; the risk of preterm delivery increased by 2.
4 times; the risk of preeclampsia increased by 3 times; hypertension and preeclampsia during pregnancy The risk of eclampsia and HELLP syndrome is increased; diabetes and the tendency to thrombosis are also increased.

The miscarriage rate of SLE patients used to be high, but in recent years it has dropped to 10%~25%.

Specific risk factors for miscarriage include proteinuria, thrombocytopenia, and antiphospholipid antibody syndrome.

 (2) Pregnancy also affects the disease activity of SLE.
According to a study of 2751 pregnancy of 1842 lupus patients, the rate of recurrence of lupus is 25.
6%.

The recurrence and aggravation of SLE can occur in all stages of pregnancy and within 3 months after delivery.

Among them, lupus nephritis (LN) is closely related to pregnancy.

After pregnancy, the risk of LN recurrence is higher.
According to data from 1984 to 2009, the recurrence rate of LN after pregnancy is as high as 26%.

Active LN increases the mortality of pregnant women, and the incidence of hypertension and preeclampsia also increases.

Figure: Definition and differentiation of preeclampsia.
The risk factors for recurrence of SLE after pregnancy are: the condition is active within 6 months before pregnancy; [58% of patients with active SLE before pregnancy have recurrence during pregnancy (more than 7 times increase); SLEDAI 4 points or more, lupus nephritis in the first 6 months of pregnancy, the risk of recurrence is high.

】Several illness activities occurred during the first year of pregnancy; illness activities during pregnancy; hydroxychloroquine (HCQ) was stopped before or during pregnancy.

(3) The impact of SLE on the fetus.
The disease activity or recurrence during pregnancy or 4 to 6 months before pregnancy is related to poor pregnancy outcome (APO), including: miscarriage, premature delivery, neonatal death, intrauterine growth retardation, and small for gestational age Children, low birth weight children.

Factors affecting pregnancy outcome include: disease activity, lupus nephritis, anti-SSA antibodies, anti-SSB antibodies, and antiphospholipid antibody syndrome.

Second, the timing and management of pregnancy In view of the huge impact of SLE on pregnant mothers and fetuses, the timing of pregnancy for women with SLE and the detection during, during and after pregnancy are very important.

 (1) Consultation before pregnancy.
Before pregnancy, you must go to the hospital for testing to assess disease activity, assess risk factors, and test for pregnancy complications (see the figure below for the process).

Figure: Flow chart of planning pregnancy for SLE women (2) During pregnancy, under the joint supervision of rheumatologists and obstetricians and gynecologists, prenatal examinations should be more frequent (see the table below).

Table: Pregnancy test items and frequency for women with SLE (3) When the mother or fetus has severe clinical symptoms, the pregnancy should be terminated in time.

Figure: Pregnancy termination conditions for systemic lupus erythematosus (4) Postpartum testing Postpartum mothers are prone to multiple complications, so postpartum testing is very important.

Postpartum disease is easy to move, and the first 4 weeks postpartum should be closely tested.
Postpartum is a period of high incidence of thrombosis.
For those who are positive for antiphospholipid antibodies, continue to use low molecular weight heparin for 4 to 6 weeks postpartum.

Due to space reasons, Xiaojie will first introduce the impact of pregnancy on the mother’s SLE and fetus and the timing and management of pregnancy.
Next week, Xiaojie will take you from the two aspects of the use of pregnancy and lactation drugs and the treatment of neonatal lupus.
Learn about the management of lupus pregnancy.

Want to know more about pregnancy in lupus patients? Xiaojie invited Professor Wu Zhenbiao from the Department of Clinical Immunology, Xijing Hospital, Air Force Military Medical University to give us a lecture on "Systemic Lupus Erythematosus Pregnancy Management".

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