Rheumatology division slide

1. SYSTEMIC LUPUS ERYTHEMATOUS
in PREGNANCY
J. Ongkowijaya, Y. Pardede

2. INTRODUCTION
Predominantly affects
young women  pregnancy
a likely occurrence in SLE
woman
Requires comprehensive
pregnancy planning  safe
mother and newborn.
Increased rate of flares  risk
of hypertensive diseases of
pregnancy, preterm birth,
miscarriages
SLE is a chronic multisystemic autoimmune disease, causes
mucocutaneous manifestations, hematologic manifestations, renal and
neurologic

4. INTRODUCTION
Recognition of disease activity and flare in pregnancy can be difficult because
physiologic changes of pregnancy may overlap with features of active disease
Systemic Lupus Erythematosus and Pregnancy. Elsevier.
2017

5. WHATDOESLUPUSDOTOTHEPREGNANCY
1. Preterm birth: Risk factors  increased disease activity (both
clinical and serologic , reflected by increasing dsDNA titers and low
complements), high prednisone use (which can cause premature
rupture of membranes), hypertension and thyroid disease
2. Preeklampsia: Risk factorslupus and lupus nephritis-specific
markers, antiphospolipid antibodies (+), trombositopenia, peexisting
hypertension, diabetes and obesity
Conducted a systematic review which evaluated 7 serum biomarkers
(ADAM12, fβ-hCG, Inhibin A, Activin A, PP13, PIGF, PAPP-A) and
Doppler ultrasound of the uterine vasculature in the first trimester to
predict preeclampsia. However, delivery of the baby is sometimes
the only definitive answer.

6. WHATDOESLUPUSDO
TOTHEPREGNANCY
3. Pregnancy loss and antiphospholipid antibodies (aPL) : aPL occur in one-
fourth to one-half patients with lupus  intrauterine growth retardation and
preterm births
The Journal of Obstetrics and Gynecology of India . Springer 2019)
Table 2 Definition of antiphospholipid syndrome

7. WHATDOESLUPUSDOTOTHENEWBORN
• Neonatal lupus a temporary condition which lasts approximately 6 to
8 months after birth.
• Maternal autoantibodies that cross the placenta.
• Characterized by a red-raised rash along with hematologic and
hepatic abnormalities.
• 10% of patients have positive SSA (anti-Ro) and SSB (anti-La)
antibodies  Can be associated with congenital heart block and
hydrops fetalis but is also associated with cardiac conduction
defects, structural abnormalities, cardiomyopathy and congestive
heart failure

8. MEDICATIONUSEDURINGPREGNANCY

9. MANAGEMENT

10. THANKYOU