Pregnancy & SLE

By
Mahmoud Baqer
Systemic Lupus Erythematosus
SLE is a complex disease, it’s cause is unknown

A combination of genetic, environmental and

hormonal factors play a role in this disease

Almost 90% of cases are in women

The prevalence in women of childbearing age is about

1 in 500 (In African American women 1:250)
Pregnancy and SLE
Important factors that determine the extent and effect
of disease in pregnant women:

 Whether the disease is active at the beginning of pregnancy – age –

parity

 Coexistence of other medical or obstetric conditions

 Whether there are APA present

Effect of Pregnancy on SLE
Maternal and fetal outcomes related to major end
organ involvement and autoantibodies

Poorer prognosis with

 CNS involvement
 Renal involvement
 HTN
 APS
..Continued
In general, most women do well during pregnancy

SLE may flare at any time during pregnancy in any

trimester as well as postpartum. It’s unpredictable!

90% of flares are mild to moderate

Most important predictor is disease activity at

conception
..Continued
CNS Lupus: refer to several different neurological or
behavioral clinical syndromes in patients with SLE

Women with CNS lupus are at high risk for pregnancy

complications

These risks may exist whether or not there are active CNS
symptoms in pregnancy
..Continued
Lupus nephropathy

 If in remission the patient will do well

 50% will develop HTN

 8-30% will have transient and reversible worsening of renal

function

 Some patients will have irreversible renal deterioration mostly

those with pre-pregnancy renal impairment.
Effect of SLE on Pregnancy
Antiphospholipid antibodies:

 Autoantibodies made against body’s own phospholipids which are important in

cell membrane structure

 Antiphospholipid antibodies are found in 50% of children with SLE

 They increase clotting tendency in blood vessels

 They also interfere with the function of the placenta in pregnancy

 Blood clots can form in placental vessels causing premature miscarriages, poor
fetal growth, preeclampsia, and stillbirth

 Some women with antiphospholipid antibodies may have trouble getting

pregnant
..Other effects
Fertility

 In general, SLE does not affect fertility of patients.

 It may be affected in a subset of people

 To preserve fertility, oral contraceptives and gonadotropin releasing

factor are used.