Best Diets for Lupus
A mother may panic about potential effects upon the fetus and cease taking her prescribed medication. In some cases sudden withdrawal of drugs can precipitate a medical crisis, such as an epileptic fit or lupus flare, with catastrophic effect on the pregnancy and fetal loss. For this reason a midwife should advise a woman to continue with her treatment until a medical practitioner with expertise in pregnancy prescribing has been consulted. The midwife may need to arrange an emergency appointment for the mother.
There is also one case report of a woman treated with hydralazine for PI H in which the fetus died 36 hours after delivery from a pericardial effusion and cardiac tamponade (Yemini 1989). A postmortem examination suggested a lupus-like syndrome possibly due to maternal and fetal sensitivity to hydralazine.
This therapy (preferably in combination with low molecular-weight heparins) is found to be effective in preventing recurrent pregnancy loss and other pregnancy complications in women with antiphospholipid syndrome, as in systemic lupus erythematosus (see also Chapter 2.9.2). Many studies indicate a benefit of low-dose aspirin, in combination with LMWHs or alone, in the treatment of high-risk thrombophilic pregnant women other studies do not confirm these findings. In one meta-analysis, aspirin treatment seemed to have, for women with moderate and high risk, a small but significant effect on reducing the rate of preterm birth, but it did not reduce the rate of perinatal death (Kozer 2003). The use of low-dose aspirin for preventing recurrent pregnancy loss and other serious obstetrical complications in women with thrombophilia remains a subject for debate (Robertson 2005, Bates 2004, Gris 2004, Brenner 2003).
Gestational AI has been associated with high rates of intrauterine growth retardation, low birth weight 31,32 , and fetal mortality 33 . A recent Italian series reported improved miscarriage rates (16 of 104 pregnancies) compared with intrauterine death rates in the 1950s of 40 to 50 34 . Most of the earlier reports consisted of previously unrecognized cases or preceded the availability of modern glucocorticoid regimens 35 . These differences have led to the speculation that, treated properly, women do not have increased complications of gestation. There does not appear to be an increased risk of preterm abortion or congenital anomalies resulting from AI alone, when patients are treated adequately 36 . However, when AI is associated with other autoimmune conditions, including positive circulating anticar-diolipin antibodies, lupus anticoagulant, and diabetes, there may be additional risks of preterm abortion 37-39 .
Lupus erythematosus, commonly known as lupus, is a serious disorder whereby the body produces autoantibodies against its own connective tissue. Two main types exist 1. Discoid lupus erythematosus (DLE) skin alone is affected, with defined, red scaly patches on the face and neck and alopecia leading to scarring on the scalp, both aggravated by sunlight3 treatment is by avoiding sunbeds or intense sunlight3 and applying topical corticosteroids or hydroxychloroquine4 2. Systemic lupus erythematosus (SLE) this condition extends beyond the skin to the organs, with enlarged lymph glands and various other manifestations2 can be fatal, especially if the kidneys are involved a. fetus is of great concern in pregnancy, as the condition often worsens, and 10 of affected mothers will transfer anti-Ro or anti-La antibodies to the fetus resulting in neonatal lupus syndrome (NLS)2 The disease has periods of remission, and when active is termed 'lupus flare' which is often triggered by infection,...
Louise Coote Lupus Unit Gassiot House St. Thomas's Hospital London SEI7EH De Swiet, M. (Ed) (2002) Thromboembolism Antiphospholipid syndrome, systemic lupus erythematosus and other connective tissue disease. In Medical Disorders in Obstetric Practice. Oxford Blackwell Scientific.
A fluid level that drops significantly prior to 34 weeks may indicate a problem with the mother or the baby. For example, some women with hypertension or lupus may have less blood flow to the uterus and, consequently, less blood flow to the placenta and the baby. When the baby receives less blood, the baby's kidneys make less urine, and that results in lower levels of amniotic fluid.
Congenital defects have been reported in three infants delivered from one mother who was treated during pregnancy with 250-500 mg day of chloroquine for discoid lupus erythematosus (15). In addition, this woman also had two normal infants, who had not been exposed to chloroquine during gestation, and one normal infant who had been exposed. Anomalies in the three infants were Wilms' tumor at age 4 years, left-sided hemihypertrophy (one infant), and cochleovestibular paresis (two infants).
Antiphospholipid antibodies are a class of antibodies that circulate in some women's blood. The two most common kinds are lupus anticoagulant and anticardiolipin antibodies. They may be found in some women with collagen vascular diseases (such as lupus), in women who have had blood clots, and in some women with no known medical problems. They're significant in pregnancy because they have been associated with recurrent miscarriages, unexplained fetal death, early onset of preeclampsia, and intrauterine growth restriction. Doctors don't routinely screen for these antibodies because many women who have them experience no resulting problems. But if you have one of the following conditions, your doctor will probably want to test you Lupus (or other collagen vascular disease)
The corticosteroids arc grouped according to their capacity for Na+ retention, their effects on carbohydrate metabolism, and their anti-inflammatory effects. Thus, glucocorticoids have pleoiotropic effects and arc used in clinical practice in (as well as replacement therapy in cases of adrenal insufficiency) treating diverse diseases such as inflammatory rheumatic disorders, asthma, autoimmune diseases (systemic lupus erythematosus and others), acute kidney transplant rejection, and allergic and skin diseases. In pregnant women at risk for preterm birth, corticosteroids are also used for the induction of lung maturity. High doses of daily glucocorticoids are usually required in patients with severe diseases involving major organs, whereas alternate-day regimens may be used in patients with less aggressive disease. Intravenous glucocorticoids (pulse therapy) are frequently used to initiate therapy in patients with rapidly progressive, inmunologically mediated diseases (Rournpas 1993).
Side effects of antithyroid drugs occur in 3-5 of treated patients. The most common complications of both drugs are pruritus and skin rash. They usually resolve by switching to the other antithyroid medication. In general, the rash occurs 2-6 weeks after initiation of therapy. Much rarer complications are migratory polyarthritis, a lupus-like syndrome, and
Cyclophosphamide is an alkylating agent used in cancer chemotherapy and as an immunosuppressant for the treatment of, for example, lupus erythematodes. Animal studies using rats, mice, rabbits, monkeys, and chicken showed malformations of the CNS, the craniofacial area and the skeleton (cf. Enns 1999). Recently, a special cyclophosphamide embryopathy Enns 1999) or embryopathy (Vaux 2003) has been proposed characteristics include craniofacial abnormalities along with eye and ear malformations, limb defccts, and growth retardation. Nine of the cases described above do at least partially follow this pattern, including those where the mothers had received cyclophosphamide as the only cytotoxic drug in connection with systemic lupus erythematosus. Treatment with cyclophosphamide during the second and third trimesters may result in pancytopenia and reduced birth weight of newborns. There is also a higher incidence of premature births (Kerr 2005). Numerous case studies have reported an...
About 3 percent of cases are associated with a disease the mother had during pregnancy, including diabetes, lupus, rubella (German measles), or phenylketonuria (PKU), a disorder involving the enzyme that processes the amino acid phenylalanine. Certain drugs taken during pregnancy, such as lithium, ethanol (alcohol), warfarin (a blood thinner), thalidomide, antimetabo-lites (such as some cancer chemotherapy drugs), and anticonvulsant (seizure) medications are also associated with an increased incidence of congenital heart defects.
Damage to the fetal retina and inner ear has been linked to chloroquine therapy in pregnancy in these cases, chloroquine was used daily in high doses on a long-term basis (Hart 1964). Such long-term, high-dose therapy may be used for other indications -for instance, in chronic inflammatory diseases. However, small series of patients taking large doses of (hydroxy)chtoroquine during pregnancy for treatment of systemic lupus erythematosus did not show an increased risk of congenital malformations or other adverse effects (Parke 1996 see also Chapter 2.1).
Immunoglobulin solutions contain primarily immunoglobulin (IgG) antibodies, and are produced from pooled human plasma. The extent to which IgG antibodies pass through the placenta is dependent on the gestational age, the dosage, the length of treatment, and the kind of preparation given. However, Fab fragments do not pass (Miller et al. 2003). Immunoglobulins are used for different maternal or fetal indications - for example, in cases of antibody deficiency or infectious diseases (especially as a preventive measure), to improve the symptoms of some maternal autoimmune diseases, or to treat the symptoms of some fetal conditions (such as, for instance, heart block in the fetuses of mothers with lupus erythematosus).
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