The mechanism behind how women suffering from systemic lupus erythematosus (SLE), an autoimmune disease, can have successful pregnancies, has been uncovered by rheumatologists at Hospital for Special Surgery in New York.
Earlier, women with SLE were advised not to have children, and in case they did conceive a child, they were advised to have therapeutic abortions to prevent severe flares of their lupus.
Now, the new research provides information that may yield insights that support a reversal of that thinking.
Titled, the PROMISSE (Predictors of pRegnancy Outcome: bioMarkers In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus) Study, the multi-center research is led by Jane Salmon, M.D., attending physician at Hospital for Special Surgery.
Salmon will present two research projects based on data gathered from the PROMISSE Study.
The researchers identified factors that help a woman and her doctor plan for a healthy pregnancy.
Lupus patients usually experience a disease "flare" quite late, when symptoms such as a red rash across the nose and cheeks, painful or swollen joints, swollen legs or extreme fatigue appear suddenly.
For the first presentation, aimed at finding if problems during pregnancy can be correlated to the severity, the researchers followed 198 pregnant patients with lupus.
They found that women who conceived while their disease was stable or only mildly active had relatively infrequent flares during their pregnancies and delivered healthy babies, regardless if past disease severity or past kidney disease
The findings inform women with lupus on how to plan when to conceive to have a low risk pregnancy.
Patients with Lupus, as well as other patients with the antiphospholipid syndrome, produce special types of proteins called antiphospholipid antibodies that can attack their own tissues and cause pregnancy complications.
The second study showed that the presence of a specific subset of these autoantibodies is linked with poor pregnancy outcomes.
In fact, they found that women having an autoantibody called lupus anticoagulant were more prone to have complications such as miscarriage or preeclampsia during pregnancy.
With the help of these findings, it is possible to identify patients at high risk for complications just by a blood test to determine if they are positive or negative for the lupus anticoagulant autoantibody.
Though it is possible for women with lupus or the antiphospholipid syndrome who are positive for this protein to have successful pregnancies, their doctors should monitor them more closely for early signs of pregnancy complications.
The two studies will be presented at this year's American College of Rheumatology meeting in San Francisco.