Systemic lupus erythematosus pregnancy

The anti-phospholipid syndrome refers to a range of autoimmune conditions which are characterised by venous or arterial thrombosis, recurrent strokes, pulmonary embolism, recurrent pregnancy loss or obstetric complications and the presence of circulating antibodies with specificity to a range of phospholipids including phosphatidylserine and cardiolipin. The syndrome is the leading cause of vascular thrombosis in children. It sometimes accompanies other autoimmune conditions such as systemic lupus erythematosus (SLE). 

Systemic Lupus Erythematosus. The use of hormonal contraception is important in women with systemic lupus erythematosus (SLE) because the risk associated with pregnancy is high in this population. It has been thought that hormonal contraception may exacerbate the symptoms of SLE. Retrospective studies have not found an association between combined OCs and disease flare-ups in these patients, but there does appear to be an association between VTE and OC use in women with SLE and antiphospholipid antibodies. Progestin-only contraceptives should be used in women with SLE and in women with a history of vascular disease or antiphospholipid antibodies, and combination OCs should be avoided. ... 

Cervera R, Font J, CarmonaF, Balasch J. Pregnancy outcome in systemic lupus erythematosus Good news for the new millennium. Autoiimnun Rev 2002 1 354-359. 

Boumpas DT, Fessler BJ, Austin HA 3rd, Balow JE, Klippel JH, Lockshin MD (1995) Systemic lupus erythematosus emerging concepts. Part 2 Dermatologic and joint disease, the antiphospholipid antibody syndrome, pregnancy and hormonal therapy, morbidity and mortality, and pathogenesis. Ann Intern Med, 123 42-53. 

Huizinga TW, van der Linder MW, Deneys-Laporte V, Breedveld FC (1999) Interleukin-10 as an explanation for pregnancy-induced flare in systemic lupus erythematosus. Rheumatology, 38 496-498. 

Khamashta MA, Ruiz-lrastorza G, Hughes GR (1997) Systemic lupus erythematosus flares during pregnancy. Rheum Dis Clin North Am, 23 15-30. 

Ruiz-lrastorza G, Khamashta MA, Gordon C, Lockshin MD, Johns KR, Sammaritano L, Hughes GR (2004) Measuring systemic lupus erythematosus activity during pregnancy validation of the lupus activity index in pregnancy scale. Arthritis Rheum, 51(1) 78-82. 

Hypersensitivity reactions include morbilliform rash in 2—5% of patients and occasionally more serious skin reactions, including Stevens-Johnson syndrome. Systemic lupus erythematosus and potentially fatal hepatic necrosis have been reported rarely. Hematological reactions include neutropenia and leucopenia, or more rarely, red-cell aplasia, agranulocytosis, and thrombocytopenia Lymphadenopathy is associated with reduced immunoglobulin A (IgA) production. Hypoprothrombinemia and hemorrhage have occurred in the newborns of mothers who received phenytoin during pregnancy vitamin K is effective treatment or prophylaxis. 

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