Pregnancy with lupus nephritis: a case report

Authors

  • Vineet Mishra Department of Obstetrics and Gynecology, IKDRC-ITS, Ahmedabad, India
  • Sugandha Goel Department of Obstetrics and Gynecology, IKDRC-ITS, Ahmedabad, India
  • Himani Aggarwal Department of Obstetrics and Gynecology, IKDRC-ITS, Ahmedabad, India
  • Sumesh Choudhary Department of Obstetrics and Gynecology, IKDRC-ITS, Ahmedabad, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20170598

Keywords:

Anti-phospholipid antibodies, Complete heart block, Fetal loss, Lupus nephritis, Pre-eclampsia, Systemic lupus erythematosus

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that commonly affects women of childbearing age. Lupus nephritis in pregnancy increases risk of maternal and fetal morbidity and mortality. Active disease during pregnancy and disease flares can lead to poor outcome. Higher rates of fetal loss, preterm birth, intra-uterine growth restriction (IUGR), and neonatal lupus syndromes, gestational diabetes, osteoporosis, avascular necrosis, hypertension, preeclampsia, ecclampsia, stroke, HELLP syndrome, and maternal death are major issues. There is difficulty in recognizing disease flare because of normal physiological changes during pregnancy. Preeclampsia mimics disease symptoms of lupus nephritis and presents confusion in diagnosis. Management option is limited to few safer drugs. Lupus nephritis with antiphospholipid antibodies presents with refractory fetal loss and complete heart block associated with anti-Ro antibodies. A multidisciplinary approach, with close medical, obstetric and neonatal monitoring, is essential for optimal outcomes. Our aim is to report a case of primigravida 37 years old with controlled lupus nephritis.

References

Mills JA. Systemic Lupus Erythematosus. N Engl J Med. 1994;330:1871.

Clark CA, Spitzer KA, Laskin CA. Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40-year period. J Rheumatol. 2005;32(9):1709-12.

Lateef A, Petri M. Management of pregnancy in systemic lupus erythematosus. Nat Rev Rheumatol. 2012;8(12):710-8.

Petri M. Hopkins Lupus Pregnancy Center: 1987 to 1996. Rheumatic Diseases Clinics of North America 1997;23: 1-13.

Rahman P, Gladman DD & Urowitz MB. Clinical predic- tors of fetal outcome in systemic lupus erythematosus. J Rheum. 1998; 25:1526-30.

Stagnaro-Green A, Akhter E, Yim C, Davies TF, Magder L, Petri M. Thyroid disease in pregnant women with systemic lupus erythematosus: increased preterm delivery. Lupus. 2011;20(7):690-9.

Hernandez RK, Werler MM, Romitti P, Sun L, Anderka M. Nonsteroidal anti-inflammatory drug use among women and the risk of birth defects. Am J Obstet Gynecol. 2012;206(3):228,221-8.

Adams K, Bombardier C, van der Heijde DM. Safety of pain therapy during pregnancy and lactation in patients with inflammatory arthritis: a systematic literature review. J Rheumatol Suppl. 2012;90:59–61.

Izmirly PM, Costedoat-Chalumeau N, Pisoni CN, Khamashta MA, Kim MY, Saxena A, Friedman D, Llanos C, Piette JC, Buyon JP. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation. 2012;126(1):76-82.

Izmirly PM, Kim MY, Llanos C, Le PU, Guerra MM, Askanase AD, Salmon JE, Buyon JP. Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine. Ann Rheum Dis. 2010;69(10):1827-30.

Ostensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, Doria A, Rai R, Meroni P, Cetin I, et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther. 2006;8(3):209.

Ostensen M, Lockshin M, Doria A, Valesini G, Meroni P, Gordon C, Brucato A, Tincani A. Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs. Rheumatology (Oxford).2008;47(3):28-31.

Del Ross T, Ruffatti A, Visentin MS, Tonello M, Calligaro A, Favaro M, Hoxha A, Punzi L. Treatment of 139 pregnancies in antiphospholipid-positive women not fulfilling criteria for antiphospholipid syndrome: a retrospective study. J Rheumatol. 2013;40(4):425-9.

Petri M, Qazi U. Management of antiphospholipid syndrome in pregnancy. Rheum Dis Clin North Am. 2006;32(3):591-607.

Hayslett JP, Lynn RI. Effect of pregnancy in patients with lupus nephropathy. Kidney Int 1980;18:207-20.

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Published

2017-02-19

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Section

Case Reports