Systemic lupus erythematosus and pregnancy

Protsenko G.O.¹, Melnychuk M.P.², Telpis D.F.², Suslova V.V.²

• ¹National Scientific Center «Institute of Cardiology, Clinical and Regenerative Medicine named after Academician M.D. Strazheskо of the National Academy of Sciences of Ukraine, Kyiv
• ²Shupyk National University of Health Care of Ukraine, Kyiv

Summary. Drug therapy of systemic lupus erythematosus (SLE) during pregnancy still remains a relevant topic despite a large number of studies and requires long-term training and a multidisciplinary team for pregnancy management, namely rheumatologist, obstetrician-gynecologist and reproductologist. Every year, more and more data appear that deepen the understanding of the disease, opening up new opportunities for treatment and prevention of exacerbations, complications for both the mother and the fetus. Results. The reviewed literature revealed a high risk of SLE exacerbations during pregnancy, a high risk of miscarriage, and the birth of children with low body weight. Currently, there are options for preserving the health of the fetus and mother through a multidisciplinary approach, pre- and post-pregnancy counseling, and adequate controlled treatment. Contrary to past beliefs, in patients with inactive or stable disease for at least 6 months, pregnancy is safer for both mother and child, with positive outcomes in about 80% of patients. Disease activity should be defined as low using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). All patients with SLE should continue to take hydroxychloroquine during pregnancy. Pregnant women at high risk of preeclampsia and eclampsia (especially those with renal involvement and antiphospholipid antibodies) should receive a prophylactic dose of acetylsalicylic acid 75–100 mg per day. Basic drugs such as sulfasalazine, tacrolimus, cyclosporine, and azathioprine can be used during pregnancy. The use of rituximab and other biological drugs is possible until conception, but their use during pregnancy should be discussed separately. The use of cyclophosphamide, leflunomide, methotrexate, and mycophenolate mofetil has a confirmed or unconfirmed teratogenic effect, so the use of these drugs is not recommended. Hormonal drugs should be limited to the maximum possible doses due to the risk of developing arterial hypertension, gestational diabetes mellitus, premature rupture of the amniotic membranes, and the birth of children with low body weight. Conclusions. Thanks to modern researchers, new groups of drugs have been created, integrative approaches to pregnancy and pre-pregnancy preparation for patients with SLE have been developed, which made it possible to preserve the health and life of the mother and child.