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A Clinician's Pearls and Myths in RheumatologyPregnancy in the Rheumatic Diseases

A Clinician's Pearls and Myths in Rheumatology: Pregnancy in the Rheumatic Diseases [Few conditions in rheumatology are fraught with greater concern and more unknowns than those of fertility and pregnancy. Patients with rheumatologic disease are not at higher risk for infertility than the general population, unless they have received cyclophosphamide. In general, the inflammation from active rheumato-logic disease is more dangerous to a pregnancy than immunosuppressant medications. Medications to continue if needed to control disease: hydroxychloroquine, azathioprine, sulfasalazine, and prednisone. Medications to discontinue prior to pregnancy: metho-trexate, leflunamide, mycophenolate mofetil, cyclophos-phamide. Normal pregnancy can alter laboratory findings. In particular, the creatinine should fall and proteinuria may increase mildly. The sedimentation rate and complement may increase. Flares in lupus during pregnancy tend to be mild. Patients at highest risk for a severe flare have active lupus at the time of conception. Even treated with low molecular weight heparin and aspirin 81mg a day, up to 25% of pregnancies in women with antiphospholipid syndrome will result in a pregnancy loss. Maternal SSA/Ro and SSB/La antibodies put a baby at risk for neonatal lupus. Up to 50% of these mothers do not fit criteria for a rheumatologic disease. Rheumatoid arthritis will improve in many women during pregnancy, but often flares post-partum. Medications may be tapered during pregnancy but should be restarted following delivery to avoid a severe flare.] http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png

A Clinician's Pearls and Myths in RheumatologyPregnancy in the Rheumatic Diseases

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Publisher
Springer London
Copyright
© Springer-Verlag London 2009
ISBN
978-1-84800-933-2
Pages
181 –190
DOI
10.1007/978-1-84800-934-9_17
Publisher site
See Chapter on Publisher Site

Abstract

[Few conditions in rheumatology are fraught with greater concern and more unknowns than those of fertility and pregnancy. Patients with rheumatologic disease are not at higher risk for infertility than the general population, unless they have received cyclophosphamide. In general, the inflammation from active rheumato-logic disease is more dangerous to a pregnancy than immunosuppressant medications. Medications to continue if needed to control disease: hydroxychloroquine, azathioprine, sulfasalazine, and prednisone. Medications to discontinue prior to pregnancy: metho-trexate, leflunamide, mycophenolate mofetil, cyclophos-phamide. Normal pregnancy can alter laboratory findings. In particular, the creatinine should fall and proteinuria may increase mildly. The sedimentation rate and complement may increase. Flares in lupus during pregnancy tend to be mild. Patients at highest risk for a severe flare have active lupus at the time of conception. Even treated with low molecular weight heparin and aspirin 81mg a day, up to 25% of pregnancies in women with antiphospholipid syndrome will result in a pregnancy loss. Maternal SSA/Ro and SSB/La antibodies put a baby at risk for neonatal lupus. Up to 50% of these mothers do not fit criteria for a rheumatologic disease. Rheumatoid arthritis will improve in many women during pregnancy, but often flares post-partum. Medications may be tapered during pregnancy but should be restarted following delivery to avoid a severe flare.]

Published: Jan 1, 2009

Keywords: Systemic Lupus Erythematosus; Pulmonary Hypertension; Lupus Nephritis; Assisted Reproductive Technology; Connective Tissue Disorder

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