New-Onset Systemic Lupus Erythematosus And Pregnancy: A Systematic Review

BackgroundSystemic lupus erythematosus(SLE) is a chronic, multi-organ autoimmune disease that occurs predominantly among reproductive age women. When SLE is newly diagnosed during pregnancy or puerperium, it is known as new-onset SLE during pregnancy. The diagnosis of new-onset SLE tends to be delayed or missed diagnosed due to similar clinical feature presentation with normal physiological changes and common pathological disease(preeclampsia) encountered during pregnancy. Furthermore, new-onset SLE during pregnancy has major organ involvement with poor maternal and fetal outcomes. In addition, certain lupus medications are potentially teratogenic and are contraindicated during pregnancy.ObjectiveThe objective of this systematic review is to investigate the clinical features, laboratory findings, treatment, complications and outcomes of new-onset SLE during pregnancies.Study methodsSystematic reviewThe MEDLINE, EMBASE, Pub Med, SCOPUS data bases related to new-onset SLE were searched up to February 2016.ResultsThis review comprises of results of 21 studies; 16 were case reports published between year 1994-2016 and remaining being retrospective study published between year 2005-2015. A total of 149 patients with new-onset SLE during pregnancy were identified and studied their course of disease. The mean maternal age of diagnosis of SLE was in their mid 20’s. The new-onset SLE generally have more severe disease with higher prevalence of renal and hematological involvement, which might have significant impact on health of mother and fetus. The most common maternal complication was preeclampsia. When lupus was missed diagnose with preeclampsia especially during third trimester it tended to delay diagnosis for 5 days to more than 12 months after delivery. Despite vigorous treatment with glucocorticoids and/or immunosupprestant, the outcome is poor with fetal loss, spontaneous abortion, preterm birth, maternal death and severe organ failure.ConclusionKnowledge and awareness of this complex disease allows physician to more effectively address and less likely for patients to suffer from missed diagnosis and inappropriate treatment. Assessment greatly depends on clinical and laboratory data along with clinical experience of the rheumatologist and obstetrician expertise on this subjectSystemic lupus Erythematosus(SLE) is a chronic, multi-organ autoimmune disease that occurs predominantly among reproductive age women. When SLE is newly diagnosed during pregnancy or puerperium, it is known as new-onset SLE during pregnancy. Delayed or missed diagnosis of new-onset SLE during pregnancy due to similar clinical manifestation of SLE with normal physiological changes of pregnancy and lupus nephritis with preeclampsia have drawn attention towards this topic. Furthermore, newonset SLE during pregnancy has major organ involvement with poor maternal and fetal outcomes. Knowledge and awareness of this complex disease allows physicians to more effectively address and less likely for patient to suffer from misdiagnosis and inappropriate treatment. This article will briefly review important issues in new-onset SLE during pregnancy and describes challenges to overcome its diagnosis.