Cases of pregnancy in patients with systemic lupus erythematosus (SLE) are not uncommon. However, the coexistence of SLE and pregnancy carries significant risks.
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Fertility of women with SLE
Is similar to the overall results for fertility in the population, although the age of first menstruation appears to be higher. Sterilisation is known to be necessary in SLE patients due to autoimmune ovarian inflammation or the presence of antiphospholipid antibodies (aPL).
These antibodies can lead to endothelial activation and thrombosis by affecting homeostasis, activation of the complement system, inhibition of protein C and annexin V. They can also deleteriously affect embryo implantation by binding to the trophoblast, inhibiting placenta formation and lowering hCG levels.
Maternal morbidity
In this group of patients is associated with SLE activity, hypertension, pre-eclampsia, haemolysis, elevated liver enzymes, the occurrence of HELLP syndrome, and aPL therapy itself. Morbidity among fetuses and newborns of mothers with SLE may be associated with prematurity, side effects of maternal therapy and the presence of maternal anti-SSA antibodies with a 1 to 2% risk of congenital atrioventricular block.
The drug hydroxychloroquine (HCQ) should continue to be taken during pregnancy. Aspirin alone is prescribed for patients with asymptomatic aPL and additionally with heparin use if the patient has a history of thrombosis or pregnancy loss.
The best predictor of pregnancy outcome is an abnormal Doppler test result. Abnormal flow in the umbilical artery in the second trimester and a previous history of thrombophlebitis can be predictors of fetal or neonatal death. Similarly, the presence of an abnormal late-diastolic indentation (notch) in uterine artery flow in the second trimester diagnosed by Doppler examination is also a predictor of adverse pregnancy outcomes.
