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Journal of Immunology Research
Volume 2015, Article ID 241547, 11 pages
http://dx.doi.org/10.1155/2015/241547
Review Article

Pregnancy Associated with Systemic Lupus Erythematosus: Immune Tolerance in Pregnancy and Its Deficiency in Systemic Lupus Erythematosus—An Immunological Dilemma

1Division of Nephrology, University of Medicine and Pharmacy “V. Babes” Timisoara, Calea Alexandru Ioan Cuza No. 8 Ap. 16, 300088 Timisoara, Romania
2Division of Nephrology, Emergency County Clinical Hospital Timisoara, Romanian Academy of Medical Sciences, Romania
3Division of Nephrology, University of Medicine and Pharmacy “V. Babes” Timisoara, Emergency County Clinical Hospital Timisoara, Romania
4Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “V. Babes” Timisoara, Emergency County Clinical Hospital Timisoara, Romania

Received 19 September 2014; Revised 5 February 2015; Accepted 6 February 2015

Academic Editor: Clelia M. Riera

Copyright © 2015 Cristina Gluhovschi 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

Pregnancy is a physiological condition that requires immune tolerance to the product of conception. Systemic lupus erythematosus (SLE) is a disease with well-represented immune mechanisms that disturb immune tolerance. The association of pregnancy with systemic lupus erythematosus creates a particular immune environment in which the immune tolerance specific of pregnancy is required to coexist with alterations of the immune system caused by SLE. The main role is played by T regulatory (Treg) cells, which attempt to regulate and adapt the immune system of the mother to the new conditions of pregnancy. Other components of the immune system also participate to maintain maternal-fetal immune tolerance. If the immune system of pregnant women with SLE is not able to maintain maternal immune tolerance to the fetus, pregnancy complications (miscarriage, fetal hypotrophy, and preterm birth) or maternal complications (preeclampsia or activation of SLE, especially in conditions of lupus nephritis) may occur. In certain situations this can be responsible for neonatal lupus. At the same time, it must be noted that during pregnancy, the immune system is able to achieve immune tolerance while maintaining the anti-infectious immune capacity of the mother. Immunological monitoring of pregnancy during SLE, as well as of the mother’s disease, is required. It is important to understand immune tolerance to grafts in transplant pathology.