Expert Perspective on a Clinical Challenge: Lupus and Pregnancy
Systemic lupus erythematosus (SLE), a multiorgan systemic inflammatory disorder, predominantly affects women during their reproductive years. In this review, we summarize the state of knowledge about preconception planning and management of SLE during pregnancy. Achieving remission or low disease ac...
Gespeichert in:
| Veröffentlicht in: | Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2024-03, Vol.76 (3), p.321-331 |
|---|---|
| Hauptverfasser: | , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 331 |
|---|---|
| container_issue | 3 |
| container_start_page | 321 |
| container_title | Arthritis & rheumatology (Hoboken, N.J.) |
| container_volume | 76 |
| creator | Tarter, Laura Bermas, Bonnie L. |
| description | Systemic lupus erythematosus (SLE), a multiorgan systemic inflammatory disorder, predominantly affects women during their reproductive years. In this review, we summarize the state of knowledge about preconception planning and management of SLE during pregnancy. Achieving remission or low disease activity for several months on medications compatible with pregnancy prior to conception is essential to decreasing the risk of disease flare and improving pregnancy outcomes, including pre‐eclampsia, preterm birth, and intrauterine growth restriction. With close management and well‐controlled disease before and during pregnancy, |
| doi_str_mv | 10.1002/art.42756 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2891755828</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2932390155</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3536-766f8631186cb6fe7e51f8608cdee6643f7d0c99c8362481d6cf86a4bcd844873</originalsourceid><addsrcrecordid>eNp1kE1Lw0AQhhdRbKk9-Ack4EUPbfcj-xEvUkL9gIJF6nnZbiY1JU3ibqP237va1oPgXGaYeXgYXoTOCR4SjOnIuM0wppKLI9SljIoBp5gfH2aSkA7qe7_CoRKJBeanqMNkIjkRuItuJ58NuE00A-cbsJviHaK6ikyUlkVVWFNG6aspS6iWcBNN26b1kamyaOZgWZnKbs_QSW5KD_1976GXu8k8fRhMn-4f0_F0YBlnYiCFyJVghChhFyIHCZyEBVY2AxAiZrnMsE0Sq5igsSKZsOFs4oXNVBwryXroaudtXP3Wgt_odeEtlKWpoG69piohknNFVUAv_6CrunVV-E7ThFGWYMJ5oK53lHW19w5y3bhibdxWE6y_g9UhWP0TbGAv9sZ2sYbslzzEGIDRDvgoStj-b9Lj5_lO-QU-VX89</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2932390155</pqid></control><display><type>article</type><title>Expert Perspective on a Clinical Challenge: Lupus and Pregnancy</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Tarter, Laura ; Bermas, Bonnie L.</creator><creatorcontrib>Tarter, Laura ; Bermas, Bonnie L.</creatorcontrib><description>Systemic lupus erythematosus (SLE), a multiorgan systemic inflammatory disorder, predominantly affects women during their reproductive years. In this review, we summarize the state of knowledge about preconception planning and management of SLE during pregnancy. Achieving remission or low disease activity for several months on medications compatible with pregnancy prior to conception is essential to decreasing the risk of disease flare and improving pregnancy outcomes, including pre‐eclampsia, preterm birth, and intrauterine growth restriction. With close management and well‐controlled disease before and during pregnancy, <10% of patients flare. All patients with SLE should remain on hydroxychloroquine unless contraindicated. Expectant mothers with a history of antiphospholipid syndrome should be treated with anticoagulant therapy during pregnancy. Women with anti‐Ro/SSA or anti‐La/SSB antibodies require additional monitoring because their offspring are at increased risk for congenital heart block. Patients with SLE should be offered low‐dose aspirin starting at the end of the first trimester to reduce the risk of pre‐eclampsia. Flares of SLE during pregnancy require escalation of therapy. The immunosuppressives azathioprine, tacrolimus, and cyclosporine are compatible with pregnancy, and biologic agents can also be considered. Glucocorticoid use in pregnancy should be limited to the lowest effective dose. Mycophenolate mofetil/mycophenolic acid, methotrexate, leflunomide, and cyclophosphamide are known to be teratogenic and are contraindicated in pregnancy. Distinguishing a flare of lupus nephritis during pregnancy from pre‐eclampsia can be particularly challenging. Overall, outcomes in pregnancy for women with lupus are improving, but gaps in knowledge about optimal management strategies persist.</description><identifier>ISSN: 2326-5191</identifier><identifier>EISSN: 2326-5205</identifier><identifier>DOI: 10.1002/art.42756</identifier><identifier>PMID: 37975160</identifier><language>eng</language><publisher>Boston, USA: Wiley Periodicals, Inc</publisher><subject>Antibodies ; Antibodies, Antinuclear ; Antiphospholipid syndrome ; Aspirin ; Autoimmune diseases ; Azathioprine ; Chronic conditions ; Congenital heart block ; Contraindications ; Cyclophosphamide ; Cyclosporins ; Disease control ; Eclampsia ; Female ; Glucocorticoids ; Health risks ; Humans ; Hydroxychloroquine ; Infant, Newborn ; Inflammatory diseases ; Leflunomide ; Lupus ; Lupus Erythematosus, Systemic ; Lupus nephritis ; Methotrexate ; Mycophenolate mofetil ; Mycophenolic acid ; Nephritis ; Offspring ; Pre-Eclampsia ; Preeclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Premature Birth ; Remission ; Risk ; Risk assessment ; Ro(SSA) antigen ; Systemic lupus erythematosus ; Tacrolimus ; Teratogenicity ; Womens health</subject><ispartof>Arthritis & rheumatology (Hoboken, N.J.), 2024-03, Vol.76 (3), p.321-331</ispartof><rights>2023 American College of Rheumatology</rights><rights>2023 American College of Rheumatology.</rights><rights>2024 American College of Rheumatology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3536-766f8631186cb6fe7e51f8608cdee6643f7d0c99c8362481d6cf86a4bcd844873</citedby><cites>FETCH-LOGICAL-c3536-766f8631186cb6fe7e51f8608cdee6643f7d0c99c8362481d6cf86a4bcd844873</cites><orcidid>0000-0002-1007-4084 ; 0009-0001-7820-0091</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fart.42756$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fart.42756$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37975160$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tarter, Laura</creatorcontrib><creatorcontrib>Bermas, Bonnie L.</creatorcontrib><title>Expert Perspective on a Clinical Challenge: Lupus and Pregnancy</title><title>Arthritis & rheumatology (Hoboken, N.J.)</title><addtitle>Arthritis Rheumatol</addtitle><description>Systemic lupus erythematosus (SLE), a multiorgan systemic inflammatory disorder, predominantly affects women during their reproductive years. In this review, we summarize the state of knowledge about preconception planning and management of SLE during pregnancy. Achieving remission or low disease activity for several months on medications compatible with pregnancy prior to conception is essential to decreasing the risk of disease flare and improving pregnancy outcomes, including pre‐eclampsia, preterm birth, and intrauterine growth restriction. With close management and well‐controlled disease before and during pregnancy, <10% of patients flare. All patients with SLE should remain on hydroxychloroquine unless contraindicated. Expectant mothers with a history of antiphospholipid syndrome should be treated with anticoagulant therapy during pregnancy. Women with anti‐Ro/SSA or anti‐La/SSB antibodies require additional monitoring because their offspring are at increased risk for congenital heart block. Patients with SLE should be offered low‐dose aspirin starting at the end of the first trimester to reduce the risk of pre‐eclampsia. Flares of SLE during pregnancy require escalation of therapy. The immunosuppressives azathioprine, tacrolimus, and cyclosporine are compatible with pregnancy, and biologic agents can also be considered. Glucocorticoid use in pregnancy should be limited to the lowest effective dose. Mycophenolate mofetil/mycophenolic acid, methotrexate, leflunomide, and cyclophosphamide are known to be teratogenic and are contraindicated in pregnancy. Distinguishing a flare of lupus nephritis during pregnancy from pre‐eclampsia can be particularly challenging. Overall, outcomes in pregnancy for women with lupus are improving, but gaps in knowledge about optimal management strategies persist.</description><subject>Antibodies</subject><subject>Antibodies, Antinuclear</subject><subject>Antiphospholipid syndrome</subject><subject>Aspirin</subject><subject>Autoimmune diseases</subject><subject>Azathioprine</subject><subject>Chronic conditions</subject><subject>Congenital heart block</subject><subject>Contraindications</subject><subject>Cyclophosphamide</subject><subject>Cyclosporins</subject><subject>Disease control</subject><subject>Eclampsia</subject><subject>Female</subject><subject>Glucocorticoids</subject><subject>Health risks</subject><subject>Humans</subject><subject>Hydroxychloroquine</subject><subject>Infant, Newborn</subject><subject>Inflammatory diseases</subject><subject>Leflunomide</subject><subject>Lupus</subject><subject>Lupus Erythematosus, Systemic</subject><subject>Lupus nephritis</subject><subject>Methotrexate</subject><subject>Mycophenolate mofetil</subject><subject>Mycophenolic acid</subject><subject>Nephritis</subject><subject>Offspring</subject><subject>Pre-Eclampsia</subject><subject>Preeclampsia</subject><subject>Pregnancy</subject><subject>Pregnancy Complications</subject><subject>Pregnancy Outcome</subject><subject>Premature Birth</subject><subject>Remission</subject><subject>Risk</subject><subject>Risk assessment</subject><subject>Ro(SSA) antigen</subject><subject>Systemic lupus erythematosus</subject><subject>Tacrolimus</subject><subject>Teratogenicity</subject><subject>Womens health</subject><issn>2326-5191</issn><issn>2326-5205</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1Lw0AQhhdRbKk9-Ack4EUPbfcj-xEvUkL9gIJF6nnZbiY1JU3ibqP237va1oPgXGaYeXgYXoTOCR4SjOnIuM0wppKLI9SljIoBp5gfH2aSkA7qe7_CoRKJBeanqMNkIjkRuItuJ58NuE00A-cbsJviHaK6ikyUlkVVWFNG6aspS6iWcBNN26b1kamyaOZgWZnKbs_QSW5KD_1976GXu8k8fRhMn-4f0_F0YBlnYiCFyJVghChhFyIHCZyEBVY2AxAiZrnMsE0Sq5igsSKZsOFs4oXNVBwryXroaudtXP3Wgt_odeEtlKWpoG69piohknNFVUAv_6CrunVV-E7ThFGWYMJ5oK53lHW19w5y3bhibdxWE6y_g9UhWP0TbGAv9sZ2sYbslzzEGIDRDvgoStj-b9Lj5_lO-QU-VX89</recordid><startdate>202403</startdate><enddate>202403</enddate><creator>Tarter, Laura</creator><creator>Bermas, Bonnie L.</creator><general>Wiley Periodicals, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1007-4084</orcidid><orcidid>https://orcid.org/0009-0001-7820-0091</orcidid></search><sort><creationdate>202403</creationdate><title>Expert Perspective on a Clinical Challenge: Lupus and Pregnancy</title><author>Tarter, Laura ; Bermas, Bonnie L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3536-766f8631186cb6fe7e51f8608cdee6643f7d0c99c8362481d6cf86a4bcd844873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Antibodies</topic><topic>Antibodies, Antinuclear</topic><topic>Antiphospholipid syndrome</topic><topic>Aspirin</topic><topic>Autoimmune diseases</topic><topic>Azathioprine</topic><topic>Chronic conditions</topic><topic>Congenital heart block</topic><topic>Contraindications</topic><topic>Cyclophosphamide</topic><topic>Cyclosporins</topic><topic>Disease control</topic><topic>Eclampsia</topic><topic>Female</topic><topic>Glucocorticoids</topic><topic>Health risks</topic><topic>Humans</topic><topic>Hydroxychloroquine</topic><topic>Infant, Newborn</topic><topic>Inflammatory diseases</topic><topic>Leflunomide</topic><topic>Lupus</topic><topic>Lupus Erythematosus, Systemic</topic><topic>Lupus nephritis</topic><topic>Methotrexate</topic><topic>Mycophenolate mofetil</topic><topic>Mycophenolic acid</topic><topic>Nephritis</topic><topic>Offspring</topic><topic>Pre-Eclampsia</topic><topic>Preeclampsia</topic><topic>Pregnancy</topic><topic>Pregnancy Complications</topic><topic>Pregnancy Outcome</topic><topic>Premature Birth</topic><topic>Remission</topic><topic>Risk</topic><topic>Risk assessment</topic><topic>Ro(SSA) antigen</topic><topic>Systemic lupus erythematosus</topic><topic>Tacrolimus</topic><topic>Teratogenicity</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tarter, Laura</creatorcontrib><creatorcontrib>Bermas, Bonnie L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tarter, Laura</au><au>Bermas, Bonnie L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Expert Perspective on a Clinical Challenge: Lupus and Pregnancy</atitle><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle><addtitle>Arthritis Rheumatol</addtitle><date>2024-03</date><risdate>2024</risdate><volume>76</volume><issue>3</issue><spage>321</spage><epage>331</epage><pages>321-331</pages><issn>2326-5191</issn><eissn>2326-5205</eissn><abstract>Systemic lupus erythematosus (SLE), a multiorgan systemic inflammatory disorder, predominantly affects women during their reproductive years. In this review, we summarize the state of knowledge about preconception planning and management of SLE during pregnancy. Achieving remission or low disease activity for several months on medications compatible with pregnancy prior to conception is essential to decreasing the risk of disease flare and improving pregnancy outcomes, including pre‐eclampsia, preterm birth, and intrauterine growth restriction. With close management and well‐controlled disease before and during pregnancy, <10% of patients flare. All patients with SLE should remain on hydroxychloroquine unless contraindicated. Expectant mothers with a history of antiphospholipid syndrome should be treated with anticoagulant therapy during pregnancy. Women with anti‐Ro/SSA or anti‐La/SSB antibodies require additional monitoring because their offspring are at increased risk for congenital heart block. Patients with SLE should be offered low‐dose aspirin starting at the end of the first trimester to reduce the risk of pre‐eclampsia. Flares of SLE during pregnancy require escalation of therapy. The immunosuppressives azathioprine, tacrolimus, and cyclosporine are compatible with pregnancy, and biologic agents can also be considered. Glucocorticoid use in pregnancy should be limited to the lowest effective dose. Mycophenolate mofetil/mycophenolic acid, methotrexate, leflunomide, and cyclophosphamide are known to be teratogenic and are contraindicated in pregnancy. Distinguishing a flare of lupus nephritis during pregnancy from pre‐eclampsia can be particularly challenging. Overall, outcomes in pregnancy for women with lupus are improving, but gaps in knowledge about optimal management strategies persist.</abstract><cop>Boston, USA</cop><pub>Wiley Periodicals, Inc</pub><pmid>37975160</pmid><doi>10.1002/art.42756</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-1007-4084</orcidid><orcidid>https://orcid.org/0009-0001-7820-0091</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2326-5191 |
| ispartof | Arthritis & rheumatology (Hoboken, N.J.), 2024-03, Vol.76 (3), p.321-331 |
| issn | 2326-5191 2326-5205 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2891755828 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Antibodies Antibodies, Antinuclear Antiphospholipid syndrome Aspirin Autoimmune diseases Azathioprine Chronic conditions Congenital heart block Contraindications Cyclophosphamide Cyclosporins Disease control Eclampsia Female Glucocorticoids Health risks Humans Hydroxychloroquine Infant, Newborn Inflammatory diseases Leflunomide Lupus Lupus Erythematosus, Systemic Lupus nephritis Methotrexate Mycophenolate mofetil Mycophenolic acid Nephritis Offspring Pre-Eclampsia Preeclampsia Pregnancy Pregnancy Complications Pregnancy Outcome Premature Birth Remission Risk Risk assessment Ro(SSA) antigen Systemic lupus erythematosus Tacrolimus Teratogenicity Womens health |
| title | Expert Perspective on a Clinical Challenge: Lupus and Pregnancy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T21%3A49%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Expert%20Perspective%20on%20a%20Clinical%20Challenge:%20Lupus%20and%20Pregnancy&rft.jtitle=Arthritis%20&%20rheumatology%20(Hoboken,%20N.J.)&rft.au=Tarter,%20Laura&rft.date=2024-03&rft.volume=76&rft.issue=3&rft.spage=321&rft.epage=331&rft.pages=321-331&rft.issn=2326-5191&rft.eissn=2326-5205&rft_id=info:doi/10.1002/art.42756&rft_dat=%3Cproquest_cross%3E2932390155%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2932390155&rft_id=info:pmid/37975160&rfr_iscdi=true |