Elahi Tabassum, Ahmed Saima, Mubarak Muhammed
Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan.
Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan.
World J Nephrol. 2024 Dec 25;13(4):99700. doi: 10.5527/wjn.v13.i4.99700.
Pregnancy in women with lupus, particularly those with lupus nephritis (LN), carries an increased risk of adverse outcomes. Women with active LN at the time of conception are at a high risk of poor maternal and fetal outcomes. Recent studies indicate that even in the presence of quiescent disease, factors such as hypertension and positive lupus anticoagulant are predictors of worse pregnancy outcomes. Consequently, pre-conception evaluation is essential to ensure that pursuing pregnancy is safe and timely, and to facilitate proper planning for optimizing medical regimens, discontinuing teratogenic agents, and treating active disease. Additionally, pre-existing LN is associated with higher rates of preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Women with lupus and prior LN can have successful pregnancies, but a multidisciplinary approach with close monitoring is essential for optimal outcomes. By systematically reviewing the available evidence, this narrative review aims to provide a comprehensive update on the complex interaction between LN and pregnancy, offering insights to guide clinical practice and future research in this field.
狼疮患者怀孕，尤其是狼疮性肾炎（LN）患者，出现不良结局的风险会增加。受孕时患有活动性LN的女性发生母婴不良结局的风险很高。最近的研究表明，即使疾病处于静止期，高血压和狼疮抗凝物阳性等因素也是妊娠结局较差的预测指标。因此，孕前评估对于确保安全、适时受孕，以及便于合理规划以优化药物治疗方案、停用致畸药物和治疗活动性疾病至关重要。此外，既往存在LN与子痫前期及溶血、肝酶升高和血小板减少综合征的发生率较高有关。患有狼疮和既往有LN的女性可以成功怀孕，但采取多学科方法并密切监测对于获得最佳结局至关重要。通过系统回顾现有证据，本叙述性综述旨在全面更新LN与妊娠之间的复杂相互作用，为指导该领域的临床实践和未来研究提供见解。
