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Lupus and pregnancy, the importance of planning

July 3, 2018

Pregnancy is a period of great physiological, hormonal and immunological changes in women. If until a few years ago, women with systemic Lupus erythematosus (SLE) were not advised to become pregnant because of the many complications and abortions, – explains Professor Carlo Selmi, Head of Clinical Rheumatology and Immunology at Humanitas and Professor at the University of Milan – today conception planning and management of pregnancy have made it possible to halve the risk of abortion. Planning for a pregnancy means discussing the matter with your rheumatologist before conception and, based on the risk factors involved, assessing the best time to minimize the risks to mother and fetus and how to avoid using certain drugs contraindicated in pregnancy. The assessment of the stage of the disease, whether or not it is positive to specific antibodies, and the presence of active nephritis, in particular, require special precautions and counseling before conception, as well as constant monitoring of the disease throughout pregnancy with a multidisciplinary approach. These women are recommended, in addition to the classic checks and examinations in pregnancy, to also undergo examinations and visits for SLE every 4-6 weeks, which include: hematological, renal and biochemical assessment, markers of inflammation, anti-dsDNA antibody levels, as well as the ecoDoppler of the umbilical and uterine arteries to establish the ideal period of childbirth, frequently caesarean, and thus reduce the risk of disease and mortality of the newborn.

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Many of the changes in pregnancy, which for a healthy woman are physiological, can mask the worsening of SLE and put the health of mother and child at risk. As shown by the results of a study conducted by the Department of Rheumatology and Clinical Immunology of Humanitas Research in collaboration with the University of California, physiological changes in pregnancy such as third-quarter anemia or increased levels of inflammation (cytokines), skin disorders, dyspnea, joint pain due to weight gain and changes in the pelvis, edema of the lower limbs, could also be caused by exacerbation of the disease and mimic complications dangerous to the life of the mother and fetus (preeclampsia, also known as gravid gestosis, and HELLP syndrome, which includes hemolysis, high levels of liver enzymes and low dosage of platelets). “To recognize when the autoimmune disease is responsible for these alterations, thanks to periodic and specific controls – concludes Professor Carlo Selmi – becomes of fundamental importance to intervene by modifying the therapy. In fact, if conception planning allows the management of therapies that could inhibit the implantation of the fetus, such as non-steroidal anti-inflammatory drugs (NSAIDs), the objective of therapeutic management is to maintain the disease in a submissive state, that is, not active, or treat complications without damaging the fetus.

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