Lupus During Pregnancy

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Lupus during pregnancy

Systemic lupus erythematosus is a predominantly autoimmune disease that affects the connective tissue of the body. During pregnancy, the process affects the placenta and fetal tissue. In the pathogenesis of the disease lies a gross violation of the immune system, leading to the destruction of healthy cells. Women of fertile age are sick more often, therefore, pregnancy against the background of this disease occurs quite often. Also during pregnancy, lupus may develop primarily.

Features of the course of lupus during pregnancy

During pregnancy, there is a shift in the hormonal balance in a woman's body, which is often the impetus for the formation of lupus erythematosus. Conversely, in a woman with an already established diagnosis of lupus, the disease may go into remission, but some time after childbirth, as a rule, the condition returns to its previous state. Or the disease can progress rapidly in the form of residual postpartum events: nephropathy, sepsis.

The onset of pregnancy in a woman aggravates the course of the disease, which poses a real threat to the life of the mother and fetus. In women diagnosed with lupus, the likelihood of complications increases significantly, much more often childbirth occurs ahead of time, the placenta exfoliates, which leads to intrauterine fetal death. The risk of giving birth to premature and developmentally delayed children is higher. Late toxicosis is much more common and much more severe.

Systemic lupus erythematosus is characterized by hematological disorders, which can be the cause of bleeding in the successive and early postpartum periods. Children born to mothers with lupus usually do not get sick and develop according to their age. But in their blood there is a placental lupus factor, which appears in the fetus from about 3-4 months of intrauterine development and disappears when the child reaches 6 months of age. Almost half of the children after birth are diagnosed with heart disease of one degree or another. After birth, children may experience transient hemorrhagic diathesis, the appearance of lupus elements on the skin, which is explained by the presence of lupus factor in the blood. In most cases, these phenomena disappear over time.

Pregnancy management in women with systemic lupus should be individualized. The issue of preservation or interruption is decided by the gynecologist together with the therapist and rheumatologist. The manifestation of the symptoms of the disease in each case, the results of the examination, the general condition of the pregnant woman is especially taken into account. Both the woman and the doctor must be prepared for any outcome.

If the disease is in an acute stage, when kidney and heart damage occurs, then pregnancy is definitely contraindicated. It can be preserved only in patients with a subacute and chronic course of the disease and only under the condition of a long, at least six months, absence of clinical and laboratory manifestations.

Unfortunately, the behavior of lupus during pregnancy cannot be predicted. In a third of women, the disease worsens, in another third, no changes may occur during the course of the disease, in the rest of women, pregnancy can lead to an improvement in the symptoms of the disease. And almost every seventh pregnant woman diagnosed with lupus develops severe complications that threaten the life of the mother and fetus.

Diagnosing lupus during pregnancy

If in a pregnant woman the symptoms of lupus appear as primary, an urgent consultation with a rheumatologist is necessary, who, based on the data of the clinical examination and the woman's complaints, determines the further tactics of the examination. To clarify the diagnosis, methods and studies are used taking into account the patient's condition.

Lupus treatment during pregnancy

Some drugs have an adverse effect on intrauterine development of the fetus, so the treatment of lupus during pregnancy has its own characteristics. Some drugs are indicated only for life-threatening conditions. It is very important that the pregnant woman receives adequate, necessary treatment with minimal risk to the baby. In no case should the course of therapy be discontinued, as this can lead to a relapse of the disease. Particular attention should be paid to the intrauterine state of the fetus.

A pregnant woman should be under the strict constant supervision of a gynecologist, rheumatologist and therapist. Since the risk of premature birth is high, it is better if the woman is monitored in a specialized clinic where there are conditions for nursing premature babies.

The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.