Guest blog by Jennifer Parker Kurkowski, NP and instructor at Baylor College of Medicine
May is Systemic Lupus Erythematosus (SLE) Awareness Month. Building awareness and knowledge of this disease is important for providers who care for women, as it primarily affects women of reproductive age. Here is a brief overview of SLE and the considerations for patients managing the condition.
What is Lupus?
SLE is a chronic autoimmune disease that can affect multiple systems throughout the body, including blood, kidneys, lungs, nervous system, serous membranes, joints, and skin. The cause of SLE is multifactorial and can include genetic, hormonal, immunologic, and environmental factors. Patients may present with a wide array of symptoms, signs, and laboratory findings. The disease is characterized by periods of remissions and relapses including a variable prognosis.
How common is Lupus?
The reported prevalence of SLE in the United States is 20 to 150 cases per 100,000. The Lupus Foundation estimates 1.5 million Americans have lupus. The female to male preponderance varies with age, emphasizing the estrogen effect. The ratio climbs as high as 15:1 in women of childbearing years. For this reason, it’s important that all providers who care for women in this population are familiar and capable of counseling patients with SLE.
How does Lupus affect pregnancy and contraceptives?
Contraceptive and preconception counseling are important for patients with SLE because it is a disease that is typically diagnosed in women of reproductive age. Here are a few things providers and patients should understand about SLE, pregnancy, or pregnancy prevention:
- Current research indicates fertility is not altered by the disease, but many medications used to treat SLE have potential teratogenic effects of which the patients should be made aware.
- Patients with SLE have an increased risk of pregnancy complications, including preterm labor, unplanned cesarean delivery, fetal growth restriction, preeclampsia, eclampsia, thrombosis, infection and transfusion. Also, patients with antiphospholipid antibodies (APL) can be at increased risk for adverse outcomes including pregnancy loss and thrombosis.
- Possible fetal complications include miscarriage, stillbirth, growth restriction, neonatal lupus and premature birth.
- Prior to conception, a woman’s SLE should be in good control or inactive for a 6-month period. Active SLE at the time of conception is linked to negative outcomes for mother and child.
Despite the maternal and fetal risks associated with SLE, many patients do not use an effective contraceptive method. The current Center for Disease Control and Prevention (CDC) medical eligibility for contraceptive use provides guidance among different patient populations. The ideal method of birth control for women with SLE depends on their APL status.
What are other health concerns for women with Lupus?
- Menstrual irregularities can be common in patients with SLE, including heavy menstrual bleeding in those with thrombocytopenia.
- Premature ovarian failure is a concern in patients receiving alkylating agents such as Cyclophosphamide (CYC). CYC is typically used in severe cases of SLE with renal or central nervous system involvement. This risk is dependent on the patient age at time of exposure and cumulative dose of CYC. It is less in women who received CYC at age 25 or younger and have a cumulative dose of less than 10 grams. Women receiving CYC must be counseled about the importance of avoiding pregnancy. The risk for teratogenicity is greatest if exposure occurs in the first trimester.
- Osteoporosis and osteopenia can be a significant problem in those patients receiving treatment with It is important to be aware of the risk for fractures. Patients should be encouraged to do weight bearing exercises, maintain a healthy weight, and stop smoking. Vitamin D levels should be checked.
- Lupus raises the risk of coronary artery disease. This is linked to hypertension and high cholesterol. One study found women with SLE are 50% more likely to have a cardiac event compared to a healthy counterpart.
- Up to half of patients with SLE have some type of renal involvement. Patients with Lupus should have periodic blood pressure checks as well as screening for lupus nephritis.
It is our responsibility as providers to ensure we and our patients understand the nuances of caring for women with Lupus so they can live full and healthy lives.