A National study of the complication of lupus in pregnancy

Department of Medicine, Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC 27710, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 06/2008; 199(2):127.e1-6. DOI: 10.1016/j.ajog.2008.03.012
Source: PubMed


This study was undertaken to determine the risk of rare complications during pregnancy for women with systemic lupus erythematosus.
By using the Nationwide Inpatient Sample from 2000-2003, we compared maternal and pregnancy complications for all pregnancy-related admissions for women with and without systemic lupus erythematosus.
Of more than 16.7 million admissions for childbirth over the 4 years, 13,555 were to women with systemic lupus erythematosus. Maternal mortality was 20-fold higher among women with systemic lupus erythematosus. The risks for thrombosis, infection, thrombocytopenia, and transfusion were each 3- to 7-fold higher for women with systemic lupus erythematosus. Lupus patients also had a higher risk for cesarean sections (odds ratio: 1.7), preterm labor (odds ratio: 2.4), and preeclampsia (odds ratio: 3.0) than other women. Women with systemic lupus erythematosus were more likely to have other medical conditions, including diabetes, hypertension, and thrombophilia, that are associated with adverse pregnancy outcomes.
Women with systemic lupus erythematosus are at increased risk for serious medical and pregnancy complications during pregnancy.

    • "Adverse pregnancy outcomes have been reported in mothers with systemic lupus erythematosus (SLE) and their offspring.123 These include preeclampsia, preterm birth, as well as stroke and even death. "

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    • "Maternal and fetal risk for serious medical and pregnancy complications is significantly higher for women with SLE than for healthy women. National analysis showed a 20-fold higher risk for maternal mortality among lupus patients, who are also at increased risk for preterm labor (OR 2.4), Cesarean section (OR 1.7), and fetal growth restriction (OR 2.6) [26]. Compared to healthy individuals, women with SLE, especially those with preexisting renal disease or with active SLE before and during pregnancy, have a higher risk for developing preeclampsia. "
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    ABSTRACT: Preeclampsia, the onset of hypertension and proteinuria during pregnancy, is a common medical disorder with high maternal and fetal mortality and morbidity. The underlying pathology remains poorly understood and includes inflammation, endothelial dysfunction, and an unbalanced thromboxane A 2 /prostacyclin ratio. For women with systemic lupus erythematosus (SLE), particularly those with preexisting renal disease or with active lupus, the risk of developing preeclampsia is up to 14% higher than it is among healthy individuals. The mechanism is still unknown and the data for preventing preeclampsia in lupus pregnancies are rare. Modulating the impaired thromboxane A 2 /prostacyclin ratio by administration of low-dose aspirin appears to be the current best option for the prevention of preeclampsia. After providing an overview of the pathogenesis of preeclampsia, preeclampsia in lupus pregnancies, and previous trials for prevention of preeclampsia with aspirin treatment, we recommend low-dose aspirin administration for all lupus patients starting prior to 16 weeks of gestation. Patients with SLE and antiphospholipid syndrome should receive treatment with heparin and low-dose aspirin during pregnancy.
    Full-text · Article · Mar 2014
    • "SLE in pregnancy, due to above factors, may present with neonatal losses, cervicitis and infertility as in our case. The risks for other serious complications, such as pre-eclampsia, hypertension, bleeding and serious infections, are also raised two-fold to eight-fold.[9] The foetal complications are higher rates of foetal loss, preterm birth, intra-uterine growth restriction (IUGR), and neonatal lupus syndromes (NLS). "
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    ABSTRACT: Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of child bearing age and may co-exist with pregnancy. Disease exacerbation, increased foetal loss, neonatal lupus and an increased incidence of pre-eclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids and immunosuppressive agents pose a high risk for both surgery and anaesthesia. We describe successful management of an antinuclear antibody (ANA) positive parturient with bad obstetric history who underwent elective caesarean section under spinal anaesthesia.
    No preview · Article · Mar 2014 · Indian journal of anaesthesia
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