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Pregnancy and Lupus

ACR Special Report: Philadelphia, PA, October 18-21, 2009

Pregnancy and Lupus

Women with lupus who become pregnant have a much higher risk of pregnancy-related complications, miscarriage, and premature delivery than women without the disease. Infants may also be born with neonatal lupus, a normally benign condition that typically disappears within a few weeks. In about 2 percent of babies, however, the condition causes fetal heart block, a potentially fatal, abnormal heart rhythm that requires a permanent pacemaker.

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.

Several presentations at the ACR meeting attested to the progress being made in this area. Specifically:

  • Markers for pregnancy complications: An analysis of the condition of 177 women involved in 406 pregnancies before and after their lupus diagnosis found that:xxv

    • Women with proliferative lupus nephritis had a higher risk of preeclampsia.
    • Women with hemolytic anemia (a condition in which not enough red blood cells are made in the body) had a higher risk for preterm delivery and preeclampsia.
    • Women with Raynaud's phenomenon had a higher risk for preterm delivery.
    • Women with antiphospholipid syndrome (a blood disorder that causes abnormal clotting) had a higher risk of miscarriages, especially in the second trimester, slow fetal growth, and preeclampsia.
    • Women who got pregnant less than six months after a flare were at higher risk of preeclampsia.

    What this means for women with lupus? Plan your pregnancy to begin at least six months after your last flare and make sure your doctors are aware that lupus nephritis, hemolytic anemia and antiphospholipid syndrome all increases your risk of complications.

  • Preventing congenital heart block: The long-awaited results of a trial designed to evaluate whether giving pregnant women intravenous immunoglobulin could prevent congenital heart block in their babies found no benefit to the therapy. However, the researchers noted, the therapy was safe and, because they used very low doses, the lack of efficacy may be related to the amount of medication the women received.xxvi This study involved ALR-funded researcher, Jill P. Buyon, MD, of New York University School of Medicine.

  • Preventing vascular complications in pregnancy: One reason for the high rates of preeclampsia and low birth weight babies in pregnant women with lupus is related to an inadequate blood supply to the placenta. Thus, the fetus doesn't get enough nourishment and fails to grow.

    Researchers, including ALR-funded scientists Jane E. Salmon, MD, of Weill Cornell Medical College, Jill P. Buyon, MD, of New York University School of Medicine, and Michelle Petri, MD, of Johns Hopkins University in Baltimore, studied 23 women with lupus who had poor outcomes in their pregnancy, 100 women with lupus who had healthy pregnancies and 98 pregnant women without lupus.

    The researchers found much higher blood levels of the molecules SFit-1 and sEng, which prevent blood vessel development, in women with poor pregnancy outcomes than in women with lupus who had healthy pregnancies or in women without lupus.xxvii

    What this means for women with lupus? Once we understand more about the mechanism behind the increase in these blood factors, we can begin to identify therapy to reduce levels.

  • Predicting neonatal lupus and its severity: In one form of neonatal lupus, a rash appears on the baby then disappears a few months later. A study presented at the ACR meeting demonstrated that a rash in one child predicted the presence of neonatal lupus in future siblings.xxviii

    Another study also found a higher risk of neonatal lupus in siblings of a child affected with neonatal lupus. However, if the first child didn't have a rash or heart block, there was little to no risk that future siblings would develop heart block. However, if the original child had heart block, there was a 15.4% risk that its siblings would also have heart block.xxix

    Finally, a third study found significantly elevated levels of enzymes called membrane-type matrix metalloproteinase-2 (MMP-2) in the cord blood of babies who developed cardiac neonatal lupus compared to those who didn't.xxx

    What this means for women with lupus? Women who had a previous child with any form of lupus nephritis should be carefully followed during subsequent pregnancies. They should also be considered for studies evaluating preventive approaches for neonatal lupus. In addition, cord blood levels of MMP-2 may one day be used to predict which babies with neonatal lupus will go on to develop heart problems.


References

xxv Fare R, Rodriguez-Almaraz E, Carreira PE, et al. Pregnancy Outcome in SLE Patients Before and After Diagnosis. Presented at 73th Annual Scientific Meeting of the American College of Rheumatology, October 20, 2009; Philadelphia, PA.

xxvi Friedman DM, Llanos C, Izmirly PM, et al. Preventive IVIG Therapy for Congenital Heart Block (PITCH). Presented at 73th Annual Scientific Meeting of the American College of Rheumatology, October 19, 2009; Philadelphia, PA.

xxvii Salmon JE, Kim MY, Rana S, et al. Angiogenic Factor Imbalance in Pregnant SLE Patients May Explain Increased Risk for Complications. Presented at 73th Annual Scientific Meeting of the American College of Rheumatology, October 20, 2009; Philadelphia, PA.

xxviii Izmirly PM, Llanos C, Buyon JP. Importance of Cutaneous Manifestations of Neonatal Lupus as a Risk Factor for Subsequent Congenital Heart Block. Presented at 73th Annual Scientific Meeting of the American College of Rheumatology, October 19, 2009; Philadelphia, PA.

xxix Danayan KC, Jaeggi E, Tyrrell PN. Recurrence of Neonatal Lupus Erythematosus in Siblings. Presented at 73th Annual Scientific Meeting of the American College of Rheumatology, October 19, 2009; Philadelphia, PA.

xxx Rivera TL, Buyon JP, Clancy RM. Elevated Matrix Metalloproteinase-2 (MMP2) Levels in Cord Blood of Anti-Ro/La Exposed Neonates Associate with the Presence and Severity of Cardiac Manifestations of Neonatal Lupus. Presented at 73th Annual Scientific Meeting of the American College of Rheumatology, October 20, 2009; Philadelphia, PA.

 

More information about lupus and treatment advances can be found by visiting www.lupusresearch.org.

The 2009 American College of Rheumatology Meeting Special Report was made possible in part by generous support from Biogen Idec, Genentech and Johnson & Johnson.

Genentech Biogen IdecJohnson & Johnson

©2009 Alliance for Lupus Research. All Rights Reserved.

Contents herein may not be reproduced, republished or distributed without the prior written permission of the Alliance for Lupus Research. To request permission to reproduce, republish or distribute any part of this report, contact us at 212-218-2840 or email info@lupusresearch.org.

 


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