The aim ofthis research article is to determine the effect and outcome of pregnancy inwomen living with Lupus. This article also aims to look at the effect ofhydroxychloroquine on pregnancy outcomes. Systemic lupus erythematous (SLE)according to (Rahana et al.), is associated with a high number of maternal andperinatal morbidity risks. Fetal growth restriction, hypertension and stillbirth is mostly common.
The most commonly used drug to modify the disease is theanti-malarial hydroxychloroquine (HCQ), the ability of this drug to produce adesired result is still not well known.A study wasconducted by Rahana et al. to examine women with pregnancies less than 20 weeksof gestation with SLE in 2001-2015.
Data was pulled from medical records andbirthing outcome system. Results show that, of the 244 pregnancies in 159 womenstudied, 86 (35%) of them used HCQ throughout their pregnancy and there were nodifferences in the complications of their pregnancies medically. There was ahigh rate of preterm birth in women taking HCQ this was due to fetal growthrestriction or compromise. This study went further to conclude that the use ofHCQ in pregnancy by women with SLE had a higher rate of iatrogenic pretermbirth (Rahana et al.). Another study by Sima et al. examined theoutcomes in women treated with and without HCQ during pregnancy.
This study wasconducted by comparing women treated with HCQ during pregnancy and women whodid not receive the drug throughout their pregnancy. the study resulted inmaternal morbidities such as fetal growth restrictions, preterm deliveries, intrauterine growth restriction, disease-relatedhospitalizations, venous thromboembolism (VTE), and death) and a composite ofneonatal morbidity. According to this study by (Sima et al.), of the 77 womenincluded in the study that had SLE, 47 of them were treated with HCQ while theremaining 30 were not treated with HCQ. Generally, there was not muchdifference in the rate of maternal morbidities between the two groups. However,it was recorded that the women getting HCQ during pregnancy had frequenthospitalizations that was related to the disease. It was concluded that therewas not much difference in the outcomes of women treated with HCQ duringpregnancy and women who did not.
In a journal byBuyon and colleagues on the issues of pregnancy with SLE, they reported about astudy 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 mightfind themselves handling the cases of women in this condition. The outcome oftheir study had a bunch of good and bad news. The good news was that 81% of thewomen studied had good pregnancy outcome i.e. the infants were born above 36weeks of gestation and survived the neonatal period. Outcomes in non-Hispanicwhite women was very good compared to African-American women.
Fetal outcome in8.2% Asian women in the study was very undesirable. Severe clinical flare,moderate clinical disease activity at baseline, thrombocytopenia and presenceof lupus anticoagulant were some of the predictors that contributed to poorfetal outcomes and ethnicity also played a role. This article also had some messagesfor the clinician who might find themselves counselling women with thiscondition who might be pregnant already or planning to. The first thing to dois to advise the patient to go for regular checkups and treatments to determinewhen the best time to get pregnant is. According to Buyon and colleagues, thepregnancy should be timed and planned to occur when the disease activity is verylow. Secondly, they stated that every pregnant woman in this condition shouldbe assigned a high-risk obstetrician and their cases should be monitoredclosely and treated as high-risk. The disease activity should be controlled andmonitored closely by the clinician.
They went further to state that theactivity and teratogenicity of some of the drugs used to treat SLE andhypertension could be a detriment to controlling and managing the diseaseactivity and flares experienced by approximately 50% of pregnant women withSLE. It was also pointed out that based on data, hydroxychloroquine is safe forthe fetus and should be used throughout pregnancy and beyond as it is helpfulin 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 pregnancyoutcomes in SLE patient. The chronic inflammatory disease can affect any organin the body and the prevalence rate varies between ethnic groups. Previous studieshave proven that women with SLE can have less complicated pregnancies if thedisease is managed appropriately.
It was advised that women with severe organdamage and systemic pulmonary hypertension, heart failure, a history of severe preeclampsia or a severe lupus farewithin the past 6 months, active lupus nephritis, or stroke may be advised notto get pregnant. A previous study by (Mintz et al.) show that women that gotpregnant when the disease is in at least 6 months of remission had higher ratesof good pregnancy outcomes (64% versus 88%). This article also stated thatthere are contraceptive options for SLE patients but it depends on some factorssuch as, disease activity, presence of antiphospholipid antibodies, age,reproductive history, cultural values and preferences. An intrauterine deviceis a safe option for this category of people due to low or no increased risk ofinfection and it can be safely combined with immunosuppressive medications. Estrogen-progesteroneis a safe option for people with a more stable condition and less diseaseactivity. Some women maydiscontinue their medications before conception due to fear of fetotoxicity isfrequent and women should be well informed that doing so may increase the activityof the SLE and lead to pregnancy complications.
During pregnancy planning, themedications should be reviewed to have current stable effects on the mother andminimize its effects on the fetus. It is encouraged to continue the use of hydroxychloroquinethroughout pregnancy due to its ability to protect against congenital heart blockand also its safe profile (Yuriko et al.). low-dose aspiring is also consideredsafe for the prevention of preeclampsia.
Although disease flares are commonduring pregnancy, there are several studies that argue that SLE activity isworsened during pregnancy while others argue there is no change in diseaseactivity. The treatment for disease flares during pregnancy is the same in anon-pregnant state. In conclusion, womenshould plan accordingly with their obstetrician and rheumatologist beforepregnancy and also be monitored closely during pregnancy. considering the highrate of premature birth, neonatal care should be readily available and fetusshould be monitored closely.