An evidence-based approach to pre-pregnancy counselling for patients with systemic lupus erythematosus

Abstract Patients with SLE are often young females of childbearing age and a pregnancy wish in this patient group is common. However, SLE patients are at high risk for adverse pregnancy outcomes that require adequate guidance. It is widely acknowledged that pre-pregnancy counselling is the pivotal f...

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Published in:Rheumatology (Oxford, England) England), 2018-10, Vol.57 (10), p.1707-1720
Main Authors: Teng, Y K Onno, Bredewold, Edwin O W, Rabelink, Ton J, Huizinga, Tom W J, Eikenboom, H C Jeroen, Limper, Maarten, Fritsch-Stork, Ruth D E, Bloemenkamp, Kitty W M, Sueters, Marieke
Format: Article
Language:English
Subjects:
Counseling
Fetuses
Lupus
Newborn babies
Patients
Pregnancy
Systemic lupus erythematosus
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Summary:Abstract Patients with SLE are often young females of childbearing age and a pregnancy wish in this patient group is common. However, SLE patients are at high risk for adverse pregnancy outcomes that require adequate guidance. It is widely acknowledged that pre-pregnancy counselling is the pivotal first step in the management of SLE patients with a wish to become pregnant. Next, management of these patients is usually multidisciplinary and often requires specific expertise from the different physicians involved. Very recently a EULAR recommendation was published emphasizing the need for adequate preconception counselling and risk stratification. Therefore the present review specifically addresses the issue of pre-pregnancy counselling for SLE patients with an evidence-based approach. The review summarizes data retrieved from recently published, high-quality cohort studies that have contributed to a better understanding and estimation of pregnancy-related risks for SLE patients. The present review categorizes risks from a patient-oriented point of view, that is, the influence of pregnancy on SLE, of SLE on pregnancy, of SLE on the foetus/neonate and of SLE-related medication. Lastly, pre-pregnancy counselling of SLE patients with additional secondary APS is reviewed. Collectively these data can guide clinicians to formulate appropriate preventive strategies and patient-tailored monitoring plans during pre-pregnancy counselling of SLE patients.
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/kex374