Grave prognostic factors of woman with SEE pregnancy include

(B) Serum creatinine >1.4 mg/dL # Pregnancy and Lupus:> Fertility rates for men and women with SLE are probably normal. However, rate of fetal loss is increased (approximately two- to threefold) in women with SLE.> Fetal demise is higher in mothers with high disease activity, antiphospholipid antibodies, and/or nephritis.> Suppression of disease activity can be achieved by administration of systemic glucocorticoids.> A placental enzyme, 11--dehydrogenase 2, deactivates glucocorticoids; it is more effective in deactivating prednisone and prednisolone than the fluorinated glucocorticoids dexamethasone and betamethasone.> Therefore, maternal SLE should be controlled with prednisone/prednisolone at the lowest effective doses for the shortest time required.> Adverse effects of prenatal glucocorticoid exposure (primarily betamethasone) on offspring may include low birth weight, developmental abnormalities in the CNS, and predilection toward adult metabolic syndrome.> In SLE patients with aPL (on at least two occasions) and prior fetal losses, treatment with heparin (standard or low-molecular- weight) plus low-dose aspirin has been shown in prospective controlled trials to increase significantly the proportion of live births.> An additional potential problem for the fetus is the presence of antibodies to Ro, sometimes associated with neonatal lupus consisting of rash and congenital heart block.> The latter can be life-threatening; therefore the presence of anti-Ro requires vigilant monitoring of fetal heart rates with prompt intervention (delivery if possible) if distress occurs.> Women with SLE usually tolerate pregnancy without disease flares.> However, a small proportion develops severe flares requiring aggressive glucocorticoid therapy or early delivery.> Poor maternal outcomes are highest in women with active nephritis or irreversible organ damage in kidneys, brain, or heart.