Today is World Lupus Day, and the latest research on lupus uncovered that lupus-related pregnancy risks in women can be identified by monitoring biomarkers in maternal blood. Pregnant women with lupus are at a higher risk of developing pregnancy complications including preeclampsia, placental insufficiency, fetal death, miscarriage, and other complications. The researchers looked at specific biomarkers in maternal blood during early pregnancy and were able to successfully predict patients who are at a higher risk to experience pregnancy complications along with identifying those who will have a normal pregnancy course. By effectively distinguishing high-risk patients, doctors would be able to counsel and manage high-risk patients early on.
Lupus is an autoimmune disease that commonly affects women during their childbearing years. In lupus, the immune system wrongfully attacks its own organs, causing damage.
Lead investigator Jane E. Salmon said, “Given that over 20 percent of pregnant women with lupus APL [antiphospholipid antibodies] experience adverse pregnancy outcomes, the ability to identify patients early in pregnancy, who are destined for poor outcomes, would significantly impact care of this high-risk population.”
The researchers conducted their study using data from the PROMISSE (Predictors of pRegnancy Outcome: bioMarker In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus) study. The researchers uncovered biomarkers that can be used to assess mothers in early pregnancy. Within 12 to 15 weeks of pregnancy, changes in biomarkers occur, which can signal complications.
The researchers found that measuring biomarkers could indicate the risk of complications. Dr. Salmon added, “Timely risk stratification of patients is important for effective clinical care and optimal allocation of healthcare resources.”
“Pregnancies in patients with SLE [systemic lupus erythematosus] and/or APL can result in poor outcomes, even when disease activity is low, and baseline clinical features and laboratory tests have only modest ability to identify patients at highest risk for adverse pregnancy outcomes. Our study is the first to demonstrate, in a prospective cohort, the usefulness of angiogenic biomarkers measured as early as the 12th week of pregnancy, in combination with clinical criteria, to identify patients with SLE and/or APL at risk of severe adverse pregnancy outcomes,” Dr. Salmon explained.
Many pregnancy complications can arise in women with lupus, including miscarriages, premature birth, and even risks to the mother. Nearly 10 percent of lupus pregnancies result in a miscarriage. First trimester miscarriages show no signs of lupus, while later trimester miscarriages are the result of antiphospholipid antibody syndrome. For this reason, all mothers should be tested for antiphospholipid antibodies.
Preterm births in lupus pregnancies are often due to preeclampsia and premature rupture of the membranes. The risk of preterm births is higher in the active lupus, high-dose prednisone, and renal disease patients.
Lastly, expecting mothers risk to experience lupus flares, which appear to be more common among pregnant women as opposed to non-pregnant women with lupus. The cause of lupus flares during pregnancy seems to be associated with the hormone prolactin, which increases during pregnancy. Other changes in hormones may also play a role, but additional research is required to confirm such speculation.
If you are a female with lupus, thinking about getting pregnant or expecting, speak with your doctor about your risks and discuss the possible ways to lower them.
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