Pregnancy

Recommendations for a woman anticipating pregnancy with a history of SLE nephritis • Stop renin–angiotensin blockade medications prior to conception: • Patients should be in remission for at least 6 months. • Follow proteinuria off angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker prior to pregnancy; expect baseline proteinuria to increase with increased glomerular filtration rate during pregnancy. • Hydroxychloroquine may help …

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What are the risks of SLE with active lupus nephritis who would like to become pregnant? We cannot use the PROMISSE study to examine the risks in a patient with LN because the study excluded patients with >1 g of proteinuria and those with a serum creatinine >1.2 mg/dL. This likely excludes many patients with …

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What preconception counseling needed for rheumatologic disease? • Timing of pregnancy should be optimized to occur when disease is controlled. • Medications should be optimized to avoid teratogenesis and to keep disease under control. • Usual recommendations apply, such as folic acid supplementation, recommended vaccinations including human papillomavirus, etc.

Rheumatic Disease and the Pregnant 1. Up to 50% to 75% of patients with rheumatoid arthritis (RA) improve during pregnancy. 2. Maternal and fetal outcomes for patients with connective tissue disease and vasculitis are best when disease is well controlled. 3. Patients with systemic lupus erythematosus (SLE) who have anti-Ro (SS-A) or anti-La (SS-B) antibodies are at increased …

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Physiologic changes that occur during pregnancy and their possible effects on patients with rheumatic diseases Other notable changes during pregnancy include: • The TH2 cytokine profile is dominant during pregnancy; this may explain why patients with SLE can flare during pregnancy while RA can improve. • IgG can cross the placenta starting at 13 to 16 weeks …

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What are the risks of pregnancy in Sjogrens Syndrome? Pregnant women who are positive for anti-SSA and/or anti-SSB have an increased risk of delivering a fetus with neonatal lupus or congenital heart block due to transplacental passage of these antibodies. This risk to the fetus is present regardless of whether the mother has SS, systemic …

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Is there any indication for plasmapheresis in pregnancy? Plasmapheresis can be safely performed during pregnancy, and introduction of plasmapheresis for specific indications has improved maternal and fetal survival rates. Plasmapheresis has been safely carried out in myasthenic crisis, Guillain-Barré syndrome, anti-GBM disease, acute fatty liver of pregnancy, and TTP. There is no indication in cardiac …

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