••• Chapter 14^ Management of Medical and Surgical Conditions in Pregnancy^149
❍ Which factors increase the risk of fetal loss?
Hypertension, active lupus, lupus nephritis, hypocomplementemia, elevated levels of anti-DNA antibodies,
antiphospholipid antibodies, or thrombocytopenia. Fetal loss usually occurs after 10 weeks’ gestation.
❍ What is the most serious complication of neonatal lupus, and which maternal antibody is it associated with?
Congenital heart block in the neonate is associated with maternal anti-Ro or SSA antibodies that cross the
placenta. The recurrence risk of congenital heart block is 15%.
❍ What fetal monitoring should be done for pregnant women with lupus?
Ultrasounds to evaluate fetal growth, weekly monitoring of the fetal heart rhythm after 16 weeks to monitor for
heart block, and biweekly nonstress tests beginning at 28 weeks.
❍ What medications to treat SLE are safe during pregnancy?
NSAIDs prior to 24 weeks and antimalarial drugs, which can be useful for skin manifestations of lupus.
Corticosteroids and azathioprine may also be used in pregnancy.
❍ What congenital malformation is associated with glucocorticoid use in pregnancy?
Cleft palate.
❍ What medications used for SLE should be avoided in pregnancy?
Cyclophosphamide is teratogenic and should be avoided, although in severe cases may be used after 12 weeks.
Methotrexate and mycophenolate mofetil should also be avoided.
ANTIPHOSPHOLIPID ANTIBODY SYNDROME
❍ What are the two antiphospholipid antibodies?
Lupus anticoagulant and anticardiolipin antibodies.
❍ What is antiphospholipid antibody syndrome?
Antiphospholipid antibodies may be found in asymptomatic patients with or without lupus; however, when
they are present and associated with recurrent thrombosis, thromobocytopenia, or second trimester fetal loss, the
diagnosis of antiphospholipid antibody syndrome is made. Anticardiolipin antibodies or lupus anticoagulant must
be identified on two occasions, at least 6 weeks apart.
❍ What percentage of women with normal, unaffected, pregnancies are positive for antiphospholipid
antibodies?
5%.
❍ What is the risk of pregnancy-related thrombosis in women with antiphospholipid antibody syndrome?
5% to 12% during pregnancy or the puerperium.
❍ What percentage of women with antiphospholipid antibody syndrome will develop preeclampsia?
Approximately one-third of women.