Pregnancy implications for systemic lupus erythematosus and the antiphospholipid syndrome Laura Andreoli a , Micaela Fredi a , Cecilia Nalli a , Rossella Reggia a , Andrea Lojacono b , Mario Motta c , Angela Tincani a, * a Rheumatology and Clinical Immunology, Spedali Civili, University of Brescia, Brescia, Italy b Obstetrics and Gynecology, Spedali Civili, University of Brescia, Brescia, Italy c Neonatology and NICU, Spedali Civili, Brescia, Italy article info Article history: Received 21 November 2011 Accepted 22 November 2011 Keywords: Systemic lupus erythematosus Antiphospholipid syndrome Pregnancy Neonatal lupus Immunosuppressive drugs Contraception Assisted reproductive techniques abstract Multidisciplinary approach and patient counselling have been the key points in the improvement of the management of pregnancy in women with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Most of these women can have successful pregnancy when thoroughly informed and instructed on several different issues. Disease activity should be in stable remission prior to pregnancy in order to reduce the chance for flare during pregnancy. To this purpose, medications must be modulated: “safe” drugs should be continued throughout pregnancy, embryotoxic/foetotoxic drugs should be withdrawn timely, and beneficial drugs such as low dose aspirin and heparin should be added for prophylaxis of maternal and foetal outcome, especially in the presence of antiphospholipid antibodies. The safety profile of anti-rheumatic drugs during pregnancy and breastfeeding should be kept constantly updated, as new data from inadvertent exposure accumulates and new drugs (especially biological agents) are available. Patients may carry autoantibodies that can negatively affect the baby, being neonatal lupus the prototypical case of passively acquired autoimmunity. Research has been greatly active in this field and more information on risk stratification and management are now available for counselling. The effect of both autoantibodies and drug exposure has been evaluated in the offspring: some concerns about learning disabilities have been raised, but these are treatable conditions that are likely to be overcome. To counsel a woman with SLE/APS during childbearing age means also to deal with contraception. Despite the “preferred choice” e combined oral contraceptive e may not be suitable for most of the patients, other options are available and should be offered and discussed with the patient. Fertility is not generally affected in SLE/APS patients, but those cases who require assisted reproduction techniques should be carefully evaluated and managed. Ó 2011 Elsevier Ltd. All rights reserved. 1. Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by a remitting and relapsing trend. SLE mainly affects young females during their reproductive years, therefore pregnancy is a topic of major interest. In early times, pregnancy was discouraged in women affected by SLE, because it was reported that the disease could become more aggressive during pregnancy, putting both the mother and the foetus at high risk. In the last 30 years, the management of the disease has greatly improved, and the approach to pregnancy along with it. SLE patients can successfully carry out a pregnancy, as long as timing and management of gestation are planned in close contact with doctors. In fact, pregnancy should be still considered a high risk period during the course of SLE, with a large number of potential complications that can influence maternal and foetal health. In particular, many SLE patients carry antiphospholipid antibodies (aPL), which are well-known risk factors for thrombotic events and pregnancy morbidity [1]. The antiphospholipid syndrome (APS) may present also as a primary form (PAPS), without any underlying systemic autoimmune disease such as SLE. Such patients are at risk for either a first obstetric failure or a recurrence of pregnancy loss. In any case, preconception counselling is essential in order to estimate the chance of both foetal and maternal problems, related to either disease activity, serologic profile or organ involvement as * Corresponding author. Rheumatology and Clinical Immunology, A.O. Spedali Civili, Piazzale Spedali Civili, 1, 25123 Brescia, Italy. Tel.: þ39 030 3995487; fax: þ39 030 3995085. E-mail address: tincani@bresciareumatologia.it (A. Tincani). Contents lists available at SciVerse ScienceDirect Journal of Autoimmunity journal homepage: www.elsevier.com/locate/jautimm 0896-8411/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.jaut.2011.11.010 Journal of Autoimmunity 38 (2012) J197eJ208