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Review
. 2018 Apr;40(4):209-224.
doi: 10.1055/s-0038-1625951. Epub 2018 Apr 27.

A Critical Review on Obstetric Follow-up of Women Affected by Systemic Lupus Erythematosus

Danilo Eduardo Abib Pastore  1 , Maria Laura Costa  1 , Mary Angela Parpinelli  1 , Fernanda Garanhani Surita  1
Affiliations
Review

A Critical Review on Obstetric Follow-up of Women Affected by Systemic Lupus Erythematosus

Danilo Eduardo Abib Pastore et al. Rev Bras Ginecol Obstet. 2018 Apr.

Abstract
in English, Portuguese

Objective: To review the existing recommendations on the prenatal care of women with systemic lupus erythematosus (SLE), based on currently available scientific evidence.

Methods: An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed), EMBASE and The Cochrane Library databases, using the medical subject headings (MeSH) terms "systemic lupus erythematosus" AND "high-risk pregnancy" OR "prenatal care." Studies published in English between 2007 and 2017 were included; experimental studies and case reports were excluded. In cases of disagreement regarding the inclusion of studies, a third senior researcher was consulted. Forty titles were initially identified; four duplicates were excluded. After reading the abstracts, 7 were further excluded and 29 were selected for a full-text evaluation.

Results: Systemic lupus erythematosus flares, preeclampsia, gestation loss, preterm birth, fetal growth restriction and neonatal lupus syndromes (mainly congenital heart-block) were the major complications described. The multidisciplinary team should adopt a specific monitoring, with particular therapeutic protocols. There are safe and effective drug options that should be prescribed for a good control of SLE activity.

Conclusion: Pregnant women with SLE present an increased risk for maternal complications, pregnancy loss and other adverse outcomes. The disease activity may worsen and, thereby, increase the risk of other maternal-fetal complications. Thus, maintaining an adequate control of disease activity and treating flares quickly should be a central goal during prenatal care.

Objetivo: Revisar as recomendações existentes sobre o cuidado pré-natal às mulheres com lúpus eritematoso sistêmico (LES), com base em evidências científicas atualmente disponíveis. MéTODOS: Revisão integrativa realizada por dois pesquisadores independentes, com base na literatura disponível nos bancos de dados MEDLINE (via PubMed), EMBASE e The Cochrane Library, usando os cabeçalhos de assuntos médicos, ou termos MeSH, “systemic lupus erythematosus” E “high-risk pregnancy” OU “prenatal care.” Estudos publicados em inglês entre 2007 e 2017 foram incluídos; estudos experimentais e relatos de caso foram excluídos. Em caso de desacordo, um terceiro pesquisador sênior foi consultado. Quarenta títulos foram inicialmente identificados; quatro duplicatas foram excluídas. Após leitura dos resumos, mais 7 artigos foram excluídos e 29 foram selecionados para uma avaliação de texto completo.

Resultados: Surtos de LES, pré-eclâmpsia, perda de gestação, parto prematuro, restrição de crescimento fetal e síndromes de lúpus neonatal foram as principais complicações descritas. A equipe multidisciplinar deve adotar um monitoramento específico, com protocolos terapêuticos apropriados. Há drogas seguras e eficazes que devem ser prescritas para um bom controle do LES. CONCLUSãO: Gestantes com LES apresentam risco aumentado de complicações maternas, perda de gravidez e outros desfechos adversos. A atividade da doença pode piorar e, assim, aumentar o risco de outras complicações. Assim, manter um controle adequado da atividade da doença e tratar rapidamente os surtos deve ser um objetivo central durante o pré-natal.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

Fig. 1
Fig. 1
PRISMA 2009 flow diagram for article's inclusion on obstetric follow-up of women affected by systemic lupus erythematosus.
See this image and copyright information in PMC

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