The onset of a pregnancy involves many changes in the woman’s physiological, hormonal and immune nature. It is not easy or possible for all women to get pregnant; think, for example, that until a few years ago, patients with systemic Lupus erythematosus (SLE) were not advised to become pregnant due to various complications and the risk of abortions.

Today, however, things have changed and as Professor Carlo Selmi, Head of Clinical Rheumatology and Immunology at Humanitas and Professor at the University of Milan explains: “The planning of conception and the management of pregnancy have also halved the risk of abortion”.


Pregnancy planning

Planning for pregnancy involves dealing with one’s own rheumatologist before conception. In the light of the risk factors involved, an assessment will be made of the best time to minimize the risks to the mother and fetus and of how not to use certain contraindicated drugs during pregnancy.

Before conception it is necessary to evaluate the phase of the disease, the positivity of specific antibodies and the presence of active nephritis: conditions that require special precautions.


Monitoring Lupus during pregnancy

Lupus will require constant monitoring, with a multidisciplinary approach, throughout the pregnancy.

These patients, in fact, in addition to the classic checks that are carried out during pregnancy, will be subjected to tests and visits for SLE every 4-6 weeks which include: hematological, renal and biochemical evaluation, markers of inflammation, and antibodies anti-dsDNA levels. The execution of the EcoDoppler of the umbilical and uterine arteries will then be indicated to establish the ideal period of childbirth, usually caesarean, and thus reduce the risk of pathologies and mortality of the newborn.


If Lupus gets worse during pregnancy

A study conducted by the Department of Clinical Rheumatology and Immunology of Humanitas in collaboration with the University of California has shown that physiological changes in pregnancy could be due to an exacerbation of the disease and represent complications dangerous to the life of the mother and fetus (preeclampsia or pregnancy gadgets and HELLP syndrome, which includes hemolysis, high levels of liver enzymes and low dosing of platelets).

Examples include third-quarter anemia, increased levels of inflammation (cytokines), skin disorders, dyspnea, joint pain related to weight gain, pelvic changes and edema of the lower limbs.

“Recognizing when an autoimmune disease is responsible for these changes, thanks to periodic and specific controls, 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 keep the disease in a submissive state, i.e. not active, or treat complications without damaging the fetus,” concluded Professor Selmi.