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The aim of
this research article is to determine the effect and outcome of pregnancy in
women living with Lupus. This article also aims to look at the effect of
hydroxychloroquine on pregnancy outcomes. Systemic lupus erythematous (SLE)
according to (Rahana et al.), is associated with a high number of maternal and
perinatal morbidity risks. Fetal growth restriction, hypertension and still
birth is mostly common. The most commonly used drug to modify the disease is the
anti-malarial hydroxychloroquine (HCQ), the ability of this drug to produce a
desired result is still not well known.

A study was
conducted by Rahana et al. to examine women with pregnancies less than 20 weeks
of gestation with SLE in 2001-2015. Data was pulled from medical records and
birthing outcome system. Results show that, of the 244 pregnancies in 159 women
studied, 86 (35%) of them used HCQ throughout their pregnancy and there were no
differences in the complications of their pregnancies medically. There was a
high rate of preterm birth in women taking HCQ this was due to fetal growth
restriction or compromise. This study went further to conclude that the use of
HCQ in pregnancy by women with SLE had a higher rate of iatrogenic preterm
birth (Rahana et al.).

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Another study by Sima et al. examined the
outcomes in women treated with and without HCQ during pregnancy. This study was
conducted by comparing women treated with HCQ during pregnancy and women who
did not receive the drug throughout their pregnancy. the study resulted in
maternal morbidities such as fetal growth restrictions, preterm deliveries, intrauterine growth restriction, disease-related
hospitalizations, venous thromboembolism (VTE), and death) and a composite of
neonatal morbidity. According to this study by (Sima et al.), of the 77 women
included in the study that had SLE, 47 of them were treated with HCQ while the
remaining 30 were not treated with HCQ. Generally, there was not much
difference in the rate of maternal morbidities between the two groups. However,
it was recorded that the women getting HCQ during pregnancy had frequent
hospitalizations that was related to the disease. It was concluded that there
was not much difference in the outcomes of women treated with HCQ during
pregnancy and women who did not.

In a journal by
Buyon and colleagues on the issues of pregnancy with SLE, they reported about a
study that was carried out in 8 centers in the united states and 1 in Canada.
In this article, there was a lot of messages directed at clinicians who might
find themselves handling the cases of women in this condition. The outcome of
their study had a bunch of good and bad news. The good news was that 81% of the
women studied had good pregnancy outcome i.e. the infants were born above 36
weeks of gestation and survived the neonatal period. Outcomes in non-Hispanic
white women was very good compared to African-American women. Fetal outcome in
8.2% Asian women in the study was very undesirable. Severe clinical flare,
moderate clinical disease activity at baseline, thrombocytopenia and presence
of lupus anticoagulant were some of the predictors that contributed to poor
fetal outcomes and ethnicity also played a role.

            This article also had some messages
for the clinician who might find themselves counselling women with this
condition who might be pregnant already or planning to. The first thing to do
is to advise the patient to go for regular checkups and treatments to determine
when the best time to get pregnant is. According to Buyon and colleagues, the
pregnancy should be timed and planned to occur when the disease activity is very
low. Secondly, they stated that every pregnant woman in this condition should
be assigned a high-risk obstetrician and their cases should be monitored
closely and treated as high-risk. The disease activity should be controlled and
monitored closely by the clinician. They went further to state that the
activity and teratogenicity of some of the drugs used to treat SLE and
hypertension could be a detriment to controlling and managing the disease
activity and flares experienced by approximately 50% of pregnant women with
SLE. It was also pointed out that based on data, hydroxychloroquine is safe for
the fetus and should be used throughout pregnancy and beyond as it is helpful
in improving both disease control and pregnancy outcomes.

            I reviewed an article by Yuriko Y.
and Shigeru A., the article was about the strategies to improve pregnancy
outcomes in SLE patient. The chronic inflammatory disease can affect any organ
in the body and the prevalence rate varies between ethnic groups. Previous studies
have proven that women with SLE can have less complicated pregnancies if the
disease is managed appropriately. It was advised that women with severe organ
damage and systemic pulmonary hypertension, heart failure, a history of severe preeclampsia or a severe lupus fare
within the past 6 months, active lupus nephritis, or stroke may be advised not
to get pregnant. A previous study by (Mintz et al.) show that women that got
pregnant when the disease is in at least 6 months of remission had higher rates
of good pregnancy outcomes (64% versus 88%). This article also stated that
there are contraceptive options for SLE patients but it depends on some factors
such as, disease activity, presence of antiphospholipid antibodies, age,
reproductive history, cultural values and preferences. An intrauterine device
is a safe option for this category of people due to low or no increased risk of
infection and it can be safely combined with immunosuppressive medications. Estrogen-progesterone
is a safe option for people with a more stable condition and less disease

            Some women may
discontinue their medications before conception due to fear of fetotoxicity is
frequent and women should be well informed that doing so may increase the activity
of the SLE and lead to pregnancy complications. During pregnancy planning, the
medications should be reviewed to have current stable effects on the mother and
minimize its effects on the fetus. It is encouraged to continue the use of hydroxychloroquine
throughout pregnancy due to its ability to protect against congenital heart block
and also its safe profile (Yuriko et al.). low-dose aspiring is also considered
safe for the prevention of preeclampsia. Although disease flares are common
during pregnancy, there are several studies that argue that SLE activity is
worsened during pregnancy while others argue there is no change in disease
activity. The treatment for disease flares during pregnancy is the same in a
non-pregnant state.

            In conclusion, women
should plan accordingly with their obstetrician and rheumatologist before
pregnancy and also be monitored closely during pregnancy. considering the high
rate of premature birth, neonatal care should be readily available and fetus
should be monitored closely.

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