Pregnancy in Women With Lupus: We Have Come So Far and Have So Far to Go
Authors: Megan E.B. Clowse
Journal: Annals of Internal Medicine (2019)

Editorials6 August 2019Pregnancy in Women With Lupus: We Have Come So Far and Have So Far to GoMegan E.B. Clowse, MD, MPHMegan E.B. Clowse, MD, MPHDuke University Medical Center, Durham, North Carolina (M.E.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1667 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Substantial progress has been made during the past 20 years in pregnancy management and outcomes in women with systemic lupus erythematosus (SLE), as Mehta and colleagues show in their current article in Annals (1). Thirty years ago, most women with SLE were advised to avoid pregnancy because of high risks for maternal and fetal morbidity and mortality. Now, this advice has shifted entirely, and most women with SLE, with careful management, can safely build a family thanks to several developments.Many prospective cohorts of pregnant women with SLE have demonstrated that disease activity in the months before and during pregnancy ...References1. Mehta B, Luo Y, Xu J, et al. Trends in maternal and fetal outcomes among pregnant women with systemic lupus erythematosus in the United States. A cross-sectional analysis. Ann Intern Med. 2019;171:164-71. doi:10.7326/M19-0120 LinkGoogle Scholar2. Fischer-Betz R, Specker C. Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol. 2017;31:397-414. [PMID: 29224680] doi:10.1016/j.berh.2017.09.011 CrossrefMedlineGoogle Scholar3. Levy RA, Vilela VS, Cataldo MJ, et al. Hydroxychloroquine (HCQ) in lupus pregnancy: double-blind and placebo-controlled study. Lupus. 2001;10:401-4. [PMID: 11434574] CrossrefMedlineGoogle Scholar4. Eudy AM, Siega-Riz AM, Engel SM, et al. Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Ann Rheum Dis. 2018;77:855-860. [PMID: 29463519] doi:10.1136/annrheumdis-2017-212535 CrossrefMedlineGoogle Scholar5. Bermas BL, Kim SC, Huybrechts K, et al. Trends in use of hydroxychloroquine during pregnancy in systemic lupus erythematosus patients from 2001 to 2015. Lupus. 2018:961203317749046. [PMID: 29301469] doi:10.1177/0961203317749046 CrossrefMedlineGoogle Scholar6. ACOG committee opinion no. 743: low-dose aspirin use during pregnancy. Obstet Gynecol. 2018;132:e44-e52. [PMID: 29939940] doi:10.1097/AOG.0000000000002708 CrossrefMedlineGoogle Scholar7. LeFevre ML; U.S. Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161:819-26. [PMID: 25200125]. doi:10.7326/M14-1884 LinkGoogle Scholar8. Mendel A, Bernatsky SB, Hanly JG, et al. Low aspirin use and high prevalence of pre-eclampsia risk factors among pregnant women in a multinational SLE inception cohort. Ann Rheum Dis. 2018. [PMID: 30573656] doi:10.1136/annrheumdis-2018-214434 CrossrefMedlineGoogle Scholar9. Hughes GR. Hughes syndrome (the antiphospholipid syndrome): a disease of our time. Inflammopharmacology. 2011;19:69-73. [PMID: 21132565] doi:10.1007/s10787-010-0071-3 CrossrefMedlineGoogle Scholar10. ACOG practice bulletin. Antepartum fetal surveillance. Number 9, October 1999 (replaces technical bulletin number 188, January 1994). Clinical management guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet. 2000;68:175-85. [PMID: 10717828] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Duke University Medical Center, Durham, North Carolina (M.E.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1667.Corresponding Author: Megan E.B. Clowse, MD, MPH, Duke University Medical Center, Box 3535, Trent Drive, Durham, NC 27710; e-mail, megan.[email protected]edu.This article was published at Annals.org on 9 July 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTrends in Maternal and Fetal Outcomes Among Pregnant Women With Systemic Lupus Erythematosus in the United States Bella Mehta , Yiming Luo , Jiehui Xu , Lisa Sammaritano , Jane Salmon , Michael Lockshin , Susan Goodman , and Said Ibrahim Metrics Cited byReproductive health 6 August 2019Volume 171, Issue 3Page: 212-213KeywordsAntiphospholipid syndromeAspirinDisclosureInpatientsLupus erythematosusMaternal mortalityMortalityPreeclampsiaPregnancyRandomized trials ePublished: 9 July 2019 Issue Published: 6 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...