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                        ==LUPUS AND PREGNANCY==

4
AUTHOR                    Lockshin MD
TITLE                     Overview of lupus pregnancies.
SOURCE                    Am J Reprod Immunol 1992
                          Oct-Dec;28(3-4):181-2
ABSTRACT                  Pregnancy in patients with systemic lupus
                          erythematosus (SLE) requires consideration of
                          5 major issues: (1) What is the risk to the
                          mother? (2) What is the risk to the fetus?
                          (3) What is the effect and treatment of
                          antiphospholipid antibody? (4) What is the
                          risk of neonatal lupus? (5) Stability of the
                          family unit, particularly in the events of
                          maternal disability or death, should be
                          discussed by all parties when a pregnancy is
                          planned. Consistency of measurement criteria,
                          standardized treatment protocols, and
                          long-term follow-ups are needed in the
                          future.

2
AUTHOR                    Buchanan NM
AUTHOR                    Khamashta MA
AUTHOR                    Morton KE
AUTHOR                    Kerslake S
AUTHOR                    Baguley EA
AUTHOR                    Hughes GR
TITLE                     A study of 100 high risk lupus pregnancies.
SOURCE                    Am J Reprod Immunol 1992
                          Oct-Dec;28(3-4):192-4
ABSTRACT                  Certain subgroups of lupus patients and those
                          with circulating antiphospholipid antibodies
                          (aPL) in particular, suffer a high rate of
                          fetal loss. Over the past 4 years, we have
                          prospectively studied 100 pregnancies in
                          patients with systemic lupus erythematosus
                          (SLE) and primary antiphospholipid syndrome.
                          In addition to conventional methods of
                          monitoring SLE and fetal development, we have
                          also used Doppler flow assessment of
                          placental perfusion from the 14th wk of
                          pregnancy onward. Patients with the
                          antiphospholipid syndrome and previous
                          history of thrombotic events were treated
                          with daily heparin (10,000 IU) and low-dose
                          aspirin (75 mg). Those without a history of
                          thrombosis were treated with low-dose
                          prednisolone, azathioprine, or
                          hydroxychloroquine. Pregnancy loss was
                          reduced from 81.3% in 101 previous
                          pregnancies to 36.8% in 100 pregnancies
                          managed by us. None of the patients who
                          received hydroxychloroquine throughout the
                          pregnancy presented fetal malformations.
                          Careful management and close monitoring of
                          the lupus pregnancy has substantially
                          improved fetal outcome.

3
AUTHOR                    Petri M
AUTHOR                    Howard D
AUTHOR                    Repke J
AUTHOR                    Goldman DW
TITLE                     The Hopkins Lupus Pregnancy Center: 1987-1991
                          update.
SOURCE                    Am J Reprod Immunol 1992
                          Oct-Dec;28(3-4):188-91
ABSTRACT                  The course of pregnancy in patients with
                          systemic lupus erythematosus is not known.
                          The Hopkins Lupus Pregnancy Center has
                          followed 64 patients (74 pregnancies)
                          prospectively since 1987. Patients are seen
                          monthly and clinical and pregnancy-related
                          data collected, with particular emphasis on
                          the occurrence of lupus flare. Flare rate
                          during pregnancy was 1.63 per person-year,
                          compared to 0.64-0.65 after delivery or in
                          non-pregnant patients. Flare did not
                          influence pregnancy outcome. Low serum C3 or
                          C4 and high anticardiolipin antibody
                          predicted pregnancy loss, and prednisone
                          dose, aspirin use, diastolic second trimester
                          blood pressure, C3 at first visit, and race
                          predicted preterm birth. Maternal flare and
                          preterm birth are important risks in lupus
                          pregnancy. The latter can be predicted from
                          maternal pregnancy data.