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Lupus Research Update: 2011 Volume 2

Volume 2, 2011 - Online Edition | In This Issue


Advances in Understanding Pregnancy and Lupus >
Lowering the Risk of Pregnancy Loss >
Faces of Lupus: Pregnancy and Lupus >

Advances in Understanding Pregnancy and Lupus

Not very long ago, doctors would often advise their female patients with lupus not to become pregnant because of the risks to both mother and unborn child — heartbreaking news for anyone who wanted to have children.

But that was 20 years ago, and thankfully much progress has since been made in the scientific understanding of the disease. In the last decade, the Alliance for Lupus Research (ALR)has been able to add its contributions to this growing body of knowledge. Intensive studies of pregnancy and lupus have yielded impressive results — which, in turn, increase the potential for future advances.

Findings Reveal SPECIFIC Risks … and NEW Hope

Because lupus primarily strikes women of reproductive age, identifying ways to predict which women and infants will have increased risks of complications has become a research priority.

A thorough analysis made by the American College of Rheumatology (ACR) has enabled researchers to identify a number of predictive markers for pregnancy and delivery complications. In observing the medical conditions of 177 women with lupus who have had 406 pregnancies, the ACR found that they face specific additional pregnancy-related risks. (A listing of these risks follows this article.)

The findings offer a solid basis for avoiding some of the complications and providing research paths for potential therapies. The ACR recommends to women with lupus that they should make sure all their doctors are aware that they have lupus and that they plan their pregnancies at least six months after their last flare.

The ALR Builds on Past Successes to Open New Pathways

By funding some of the world’s most pioneering scientific investigations, the ALR plays an enormous role in advancing lupus research, including an increased understanding of lupus during pregnancy. Building on past successes, we aim to defeat lupus — in all its manifestations — for good!

With funding from the ALR, Jane E. Salmon, MD, of Weill Cornell Medical College, is investigating pregnancy loss among women with lupus. Dr. Salmon proposed and evaluated a novel hypothesis: “We theorized that such pregnancy loss was critically dependent on the activation of the inflammatory process in the placenta,” she said.

Dr. Salmon's team demonstrated that inhibiting the inflammation dramatically reduced fetal loss and growth restriction. This is encouraging news — not only because one of the lupus mechanisms has been identified for this syndrome, but also because there are several currently approved drugs that block this inflammation process.

Today Dr. Salmon is studying more genes in this pathway and measuring circulating proteins in blood early in pregnancy. This may take more years of research but Dr. Salmon has a goal of developing a risk profile to guide patients and physicians.

Working toward the same aim is internationally recognized Jill P. Buyon, MD, of New York University School of Medicine. With a long-term association with the ALR, Dr. Buyon has been opening pathways to a better understanding of neonatal lupus and pregnancy in lupus for more than 25 years.

Jill Buyon, MD Dr. Buyon’s vast work in lupus and pregnancy includes investigations on neonatal heart blockage, premature delivery, and preeclampsia, a condition that causes high blood pressure and large losses of protein.

With her vast experience, Dr. Buyon remains optimistic:“Most women with lupus do well during pregnancy, although premature birth and pre eclampsia still remain a threat for some. Pre-pregnancy counseling should be emphasized.  Careful monitoring is key and in terms of lupus medicines, women should continue to take what they've been prescribed unless the doctor instructs them on specific changes which may include several of the immunosuppressives and anti-hypertensives.”

Striving for Better Treatments Today... and a Cure for Tomorrow

The ALR pursues multiple approaches to a fuller understanding of lupus — including how it increases risks of complications for pregnant women. While searching for a cure, our investigations also aim to reduce risk and improve therapies for women with lupus who want to have children.

Dr. Jane Salmon and Dr. Jill P. Buyon are world renowned for their critical work achievements in the study of neonatal lupus and pregnancy in lupus. The National Institute of Health (NIH) is currently funding Dr. Salmon’s work.

 

American College of Rheumatology (ACR) has identified a number of predictive markers for pregnancy and delivery complications:
 
  • Proliferative lupus nephritis - increases risk for preeclampsia.
  • Hemolytic anemia - increases risk for preterm delivery and preeclampsia.
  • Raynaud's phenomenon - increases risks for preterm delivery.
  • Antiphospholipid syndrome (a blood disorder) - increases risks for miscarriages, slow fetal growth, and preeclampsia.
  • Pregnancy less than six months after a flare - increases risk for preeclampsia.

 


1.5 million

people in the U.S. have Lupus.

100 million

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