Lupus and pregnancy

Lupus causes an increased rate of fetal death in utero and spontaneous abortion (miscarriage). The overall live-birth rate in somebody with lupus has been estimated to be 72%. Pregnancy outcome appears to be worse in those with lupus whose disease flares up during pregnancy. Miscarriages in the first trimester appear either to have no known cause or to be associated with signs of active lupus. Later losses appear to occur primarily due to the antiphospholipid syndrome, in spite of treatment with heparin and aspirin. All women with lupus, even those without previous history of miscarriage, are recommended to be screened for antiphospholipid antibodies, both the lupus anticoagulant (the RVVT and sensitive PTT are the best screening battery) and anticardiolipin antibodies. ==Neonatal lupus==

Neonatal lupus is the occurrence of lupus symptoms in an infant born from a mother with lupus, most commonly presenting with a rash resembling discoid lupus erythematosus, and sometimes with systemic abnormalities such as heart block or hepatosplenomegaly. Neonatal lupus is usually benign and self-limited. ==Aggravation of lupus==

Aggravation (or exacerbation) of lupus has been estimated to occur in about 20-30% pregnancies where the mother has lupus. with an incidence of 7-33% in women who have been in remission for at least 6 months, and an incidence of 61-67% in women who have active lupus at the time of conception. Also, in the postpartum period, there may be exacerbations of lupus due to decreased levels of anti-inflammatory steroids, elevated levels of prolactin and estrogen and progesterone changes. In diagnosing an aggravation of lupus in pregnancy, there need to be a differential diagnosis from lupus-unrelated complications of pregnancy that may appear in a similar fashion. For example, chloasma may appear like the malar rash of lupus, proteinuria from preeclampsia may appear like that of lupus nephritis, thrombocytopenia of the HELLP syndrome may appear like that of lupus, and pregnancy-related edema of joints can appear like arthritis of lupus. ==General preventive measures==

Continuing glucocorticoids at the lowest effective dose and/or cautious use of azathioprine may be preferred in some patients, but needs to be weighed against potential adverse effects of such medications. ==References==