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Autoimmune Diseases
Volume 2015, Article ID 943490, 18 pages
http://dx.doi.org/10.1155/2015/943490
Review Article

Understanding and Managing Pregnancy in Patients with Lupus

1Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
2Systemic Autoimmune Diseases Research Unit, Hospital General Regional No. 36-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico
3Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
4Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

Received 1 April 2015; Accepted 31 May 2015

Academic Editor: Juan-Manuel Anaya

Copyright © 2015 Guilherme Ramires de Jesus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6–12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies.