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Systemic lupus erythematosus in pregnancy

Department of Rheumatology, King's College Hospital, London, UK

Trevor Beedham, MRCS LRCP BDS MIBiol FRCOG, Consultant Obstetrician and Gynaecologist

Women & Children's Directorate, 3rd Floor, Fielden House, The Royal London Hospital, Whitechapel, London E1 1BB, UK email: Trevor.Beedham{at}barts&thelondon.nhs.uk (corresponding author)

Munther Khamashta, MD FRCP PhD, Consultant Physician and Deputy Head

Lupus Research Unit, Rayne Institute, St. Thomas' Hospital, London, UK

David D'Cruz, MD FRCP, Honorary Senior Lecturer and Consultant Rheumatologist

Lupus Research Unit, St. Thomas' Hospital, London, UK

When a woman is known to have systemic lupus erythematosis, planning and preparation can improve the outcome of pregnancy and reduce the severity of some of the potential problems. All treatment options have risks but these risks have to be balanced against the risks of no treatment or, `too late' treatment. In pregnancy, close fetal surveillance is important. Once there are definite signs of fetal harm this cannot always be corrected and late management decisions can only institute rescue. Urgent premature delivery is a frequent phenomenon. Proactive medical care of the mother, together with accurate information about the state of the baby, may reduce the frequency of sudden or early delivery thereby assisting neonatal management. Currently, some risks such as neonatal lupus with congenital heart block, retain a high mortality. The construction of an agreed detailed prospective management plan, understood by all those involved, can lead to increased satisfaction with the care process and a better outcome.

Keywords Keywords / autoimmune disease / miscarriage / neonatal disease / nephritis / teratogenicity / thrombosis