Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2001 Mar;77(905):157–165. doi: 10.1136/pmj.77.905.157

Pregnancy in systemic lupus erythematosus

C Mok 1, R Wong 1
PMCID: PMC1741938  PMID: 11222822

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women of reproductive age. Pregnancy and its outcome is a major concern to most SLE patients. Queries regarding the risk of disease flares during pregnancy, chance of fetal loss, and the safety of various drugs are often raised. With the improvement in the understanding of the pathogenesis of SLE and the judicious use of immunosuppressive drugs, better disease control can now be achieved and SLE patients should not be deprived of the opportunity for bearing children. Prepregnancy counselling and close collaboration with other specialists such as the obstetricians and the perinatologists is essential in optimising the maternal and fetal outcome in lupus pregnancies. In this review, important issues regarding the fertility rate, optimal timing of conception, risk of disease flares during lupus pregnancy, pregnancy course, fetal outcome, safety of various drugs used for disease control during pregnancy and lactation, and contraceptive advice are discussed.


Keywords: systemic lupus erythematosus; pregnancy; flare; hormone

Full Text

The Full Text of this article is available as a PDF (145.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armenti V. T., Ahlswede K. M., Ahlswede B. A., Cater J. R., Moritz M. J., Burke J. F. National Transplantation Pregnancy Registry: analysis of outcome/risks of 394 pregnancies in kidney transplant recipients. Transplant Proc. 1994 Oct;26(5):2535–2535. [PubMed] [Google Scholar]
  2. Armenti V. T., Ahlswede K. M., Ahlswede B. A., Jarrell B. E., Moritz M. J., Burke J. F. National transplantation Pregnancy Registry--outcomes of 154 pregnancies in cyclosporine-treated female kidney transplant recipients. Transplantation. 1994 Feb 27;57(4):502–506. [PubMed] [Google Scholar]
  3. Asherson R. A., Harris E. N., Hughes G. R., Farquharson R. G. Complications of oral contraceptives and antiphospholipid antibodies: reply to the letter by Bruneau et al. Arthritis Rheum. 1988 Apr;31(4):575–576. doi: 10.1002/art.1780310424. [DOI] [PubMed] [Google Scholar]
  4. Barrett J. H., Brennan P., Fiddler M., Silman A. Breast-feeding and postpartum relapse in women with rheumatoid and inflammatory arthritis. Arthritis Rheum. 2000 May;43(5):1010–1015. doi: 10.1002/1529-0131(200005)43:5<1010::AID-ANR8>3.0.CO;2-O. [DOI] [PubMed] [Google Scholar]
  5. Bermas B. L., Hill J. A. Effects of immunosuppressive drugs during pregnancy. Arthritis Rheum. 1995 Dec;38(12):1722–1732. doi: 10.1002/art.1780381203. [DOI] [PubMed] [Google Scholar]
  6. Bobrie G., Liote F., Houillier P., Grünfeld J. P., Jungers P. Pregnancy in lupus nephritis and related disorders. Am J Kidney Dis. 1987 Apr;9(4):339–343. doi: 10.1016/s0272-6386(87)80133-6. [DOI] [PubMed] [Google Scholar]
  7. Boumpas D. T., Austin H. A., 3rd, Vaughan E. M., Yarboro C. H., Klippel J. H., Balow J. E. Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Ann Intern Med. 1993 Sep 1;119(5):366–369. doi: 10.7326/0003-4819-119-5-199309010-00003. [DOI] [PubMed] [Google Scholar]
  8. Boumpas D. T., Balow J. E. Outcome criteria for lupus nephritis trials: a critical overview. Lupus. 1998;7(9):622–629. doi: 10.1191/096120398678920758. [DOI] [PubMed] [Google Scholar]
  9. Branch D. W., Silver R. M., Blackwell J. L., Reading J. C., Scott J. R. Outcome of treated pregnancies in women with antiphospholipid syndrome: an update of the Utah experience. Obstet Gynecol. 1992 Oct;80(4):614–620. [PubMed] [Google Scholar]
  10. Buchanan N. M., Toubi E., Khamashta M. A., Lima F., Kerslake S., Hughes G. R. Hydroxychloroquine and lupus pregnancy: review of a series of 36 cases. Ann Rheum Dis. 1996 Jul;55(7):486–488. doi: 10.1136/ard.55.7.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Buskila D., Lorber M., Neumann L., Flusser D., Shoenfeld Y. No correlation between prolactin levels and clinical activity in patients with systemic lupus erythematosus. J Rheumatol. 1996 Apr;23(4):629–632. [PubMed] [Google Scholar]
  12. Buyon J. P., Cronstein B. N., Morris M., Tanner M., Weissmann G. Serum complement values (C3 and C4) to differentiate between systemic lupus activity and pre-eclampsia. Am J Med. 1986 Aug;81(2):194–200. doi: 10.1016/0002-9343(86)90251-2. [DOI] [PubMed] [Google Scholar]
  13. Buyon J. P., Hiebert R., Copel J., Craft J., Friedman D., Katholi M., Lee L. A., Provost T. T., Reichlin M., Rider L. Autoimmune-associated congenital heart block: demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J Am Coll Cardiol. 1998 Jun;31(7):1658–1666. doi: 10.1016/s0735-1097(98)00161-2. [DOI] [PubMed] [Google Scholar]
  14. Buyon J. P., Kalunian K. C., Ramsey-Goldman R., Petri M. A., Lockshin M. D., Ruiz-Irastorza G., Khamashta M. Assessing disease activity in SLE patients during pregnancy. Lupus. 1999;8(8):677–684. doi: 10.1191/096120399680411272. [DOI] [PubMed] [Google Scholar]
  15. Chapel T. A., Burns R. E. Oral contraceptives and exacerbation of lupus erythematosus. Am J Obstet Gynecol. 1971 Jun 1;110(3):366–369. doi: 10.1016/0002-9378(71)90730-7. [DOI] [PubMed] [Google Scholar]
  16. Cowchock F. S., Reece E. A., Balaban D., Branch D. W., Plouffe L. Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin treatment. Am J Obstet Gynecol. 1992 May;166(5):1318–1323. doi: 10.1016/0002-9378(92)91596-3. [DOI] [PubMed] [Google Scholar]
  17. Dekker G. A., de Vries J. I., Doelitzsch P. M., Huijgens P. C., von Blomberg B. M., Jakobs C., van Geijn H. P. Underlying disorders associated with severe early-onset preeclampsia. Am J Obstet Gynecol. 1995 Oct;173(4):1042–1048. doi: 10.1016/0002-9378(95)91324-6. [DOI] [PubMed] [Google Scholar]
  18. FRASER F. C., FAINSTAT T. D. Production of congenital defects in the off-spring of pregnant mice treated with cortisone; progress report. Pediatrics. 1951 Oct;8(4):527–533. [PubMed] [Google Scholar]
  19. Furukawa F., Tachibana T., Imamura S., Tamura T. Oral contraceptive-induced lupus erythematosus in a Japanese woman. J Dermatol. 1991 Jan;18(1):56–58. doi: 10.1111/j.1346-8138.1991.tb03041.x. [DOI] [PubMed] [Google Scholar]
  20. Garovich M., Agudelo C., Pisko E. Oral contraceptives and systemic lupus erythematosus. Arthritis Rheum. 1980 Dec;23(12):1396–1398. doi: 10.1002/art.1780231213. [DOI] [PubMed] [Google Scholar]
  21. Ginsberg J. S., Brill-Edwards P., Johnston M., Denburg J. A., Andrew M., Burrows R. F., Bensen W., Cividino A., Long A. A. Relationship of antiphospholipid antibodies to pregnancy loss in patients with systemic lupus erythematosus: a cross-sectional study. Blood. 1992 Aug 15;80(4):975–980. [PubMed] [Google Scholar]
  22. Hayslett J. P., Lynn R. I. Effect of pregnancy in patients with lupus nephropathy. Kidney Int. 1980 Aug;18(2):207–220. doi: 10.1038/ki.1980.129. [DOI] [PubMed] [Google Scholar]
  23. Hou S. H., Grossman S. D., Madias N. E. Pregnancy in women with renal disease and moderate renal insufficiency. Am J Med. 1985 Feb;78(2):185–194. doi: 10.1016/0002-9343(85)90425-5. [DOI] [PubMed] [Google Scholar]
  24. Hou S. H. Pregnancy in women on haemodialysis and peritoneal dialysis. Baillieres Clin Obstet Gynaecol. 1994 Jun;8(2):481–500. doi: 10.1016/s0950-3552(05)80332-3. [DOI] [PubMed] [Google Scholar]
  25. Houser M. T., Fish A. J., Tagatz G. E., Williams P. P., Michael A. F. Pregnancy and systemic lupus erythematosus. Am J Obstet Gynecol. 1980 Oct 15;138(4):409–413. doi: 10.1016/0002-9378(80)90138-6. [DOI] [PubMed] [Google Scholar]
  26. Jara-Quezada L., Graef A., Lavalle C. Prolactin and gonadal hormones during pregnancy in systemic lupus erythematosus. J Rheumatol. 1991 Mar;18(3):349–353. [PubMed] [Google Scholar]
  27. Jick H., Holmes L. B., Hunter J. R., Madsen S., Stergachis A. First-trimester drug use and congenital disorders. JAMA. 1981 Jul 24;246(4):343–346. [PubMed] [Google Scholar]
  28. Julkunen H. A., Kaaja R., Friman C. Contraceptive practice in women with systemic lupus erythematosus. Br J Rheumatol. 1993 Mar;32(3):227–230. doi: 10.1093/rheumatology/32.3.227. [DOI] [PubMed] [Google Scholar]
  29. Julkunen H. A. Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE. Scand J Rheumatol. 1991;20(6):427–433. doi: 10.3109/03009749109096822. [DOI] [PubMed] [Google Scholar]
  30. Julkunen H., Kaaja R., Palosuo T., Grönhagen-Riska C., Teramo K. Pregnancy in lupus nephropathy. Acta Obstet Gynecol Scand. 1993 May;72(4):258–263. doi: 10.3109/00016349309068034. [DOI] [PubMed] [Google Scholar]
  31. Julkunen H., Kaaja R., Siren M. K., Mack C., McCready S., Holthöfer H., Kurki P., Maddison P. Immune-mediated congenital heart block (CHB): identifying and counseling patients at risk for having children with CHB. Semin Arthritis Rheum. 1998 Oct;28(2):97–106. doi: 10.1016/s0049-0172(98)80042-5. [DOI] [PubMed] [Google Scholar]
  32. Jungers P., Dougados M., Pélissier C., Kuttenn F., Tron F., Lesavre P., Bach J. F. Influence of oral contraceptive therapy on the activity of systemic lupus erythematosus. Arthritis Rheum. 1982 Jun;25(6):618–623. doi: 10.1002/art.1780250603. [DOI] [PubMed] [Google Scholar]
  33. Jungers P., Dougados M., Pélissier C., Kuttenn F., Tron F., Lesavre P., Bach J. F. Lupus nephropathy and pregnancy. Report of 104 cases in 36 patients. Arch Intern Med. 1982 Apr;142(4):771–776. doi: 10.1001/archinte.142.4.771. [DOI] [PubMed] [Google Scholar]
  34. Kaufman R. L., Kitridou R. C. Pregnancy in mixed connective tissue disease: comparison with systemic lupus erythematosus. J Rheumatol. 1982 Jul-Aug;9(4):549–555. [PubMed] [Google Scholar]
  35. Khamashta M. A., Hughes G. R. Pregnancy in systemic lupus erythematosus. Curr Opin Rheumatol. 1996 Sep;8(5):424–429. doi: 10.1097/00002281-199609000-00006. [DOI] [PubMed] [Google Scholar]
  36. Khamashta M. A., Ruiz-Irastorza G., Hughes G. R. Systemic lupus erythematosus flares during pregnancy. Rheum Dis Clin North Am. 1997 Feb;23(1):15–30. doi: 10.1016/s0889-857x(05)70312-4. [DOI] [PubMed] [Google Scholar]
  37. Kutteh W. H. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am J Obstet Gynecol. 1996 May;174(5):1584–1589. doi: 10.1016/s0002-9378(96)70610-5. [DOI] [PubMed] [Google Scholar]
  38. Kutteh W. H., Ermel L. D. A clinical trial for the treatment of antiphospholipid antibody-associated recurrent pregnancy loss with lower dose heparin and aspirin. Am J Reprod Immunol. 1996 Apr;35(4):402–407. doi: 10.1111/j.1600-0897.1996.tb00501.x. [DOI] [PubMed] [Google Scholar]
  39. Langevitz P., Klein L., Pras M., Many A. The effect of cyclophosphamide pulses on fertility in patients with lupus nephritis. Am J Reprod Immunol. 1992 Oct-Dec;28(3-4):157–158. doi: 10.1111/j.1600-0897.1992.tb00780.x. [DOI] [PubMed] [Google Scholar]
  40. Lewis R. B., Schulman J. D. Influence of acetylsalicylic acid, an inhibitor of prostaglandin synthesis, on the duration of human gestation and labour. Lancet. 1973 Nov 24;2(7839):1159–1161. doi: 10.1016/s0140-6736(73)92934-6. [DOI] [PubMed] [Google Scholar]
  41. Lockshin M. D., Druzin M. L., Goei S., Qamar T., Magid M. S., Jovanovic L., Ferenc M. Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus. N Engl J Med. 1985 Jul 18;313(3):152–156. doi: 10.1056/NEJM198507183130304. [DOI] [PubMed] [Google Scholar]
  42. Lockshin M. D., Reinitz E., Druzin M. L., Murrman M., Estes D. Lupus pregnancy. Case-control prospective study demonstrating absence of lupus exacerbation during or after pregnancy. Am J Med. 1984 Nov;77(5):893–898. doi: 10.1016/0002-9343(84)90538-2. [DOI] [PubMed] [Google Scholar]
  43. Loizou S., Byron M. A., Englert H. J., David J., Hughes G. R., Walport M. J. Association of quantitative anticardiolipin antibody levels with fetal loss and time of loss in systemic lupus erythematosus. Q J Med. 1988 Jul;68(255):525–531. [PubMed] [Google Scholar]
  44. Martínez-Rueda J. O., Arce-Salinas C. A., Kraus A., Alcocer-Varela J., Alarcón-Segovia D. Factors associated with fetal losses in severe systemic lupus erythematosus. Lupus. 1996 Apr;5(2):113–119. doi: 10.1177/096120339600500205. [DOI] [PubMed] [Google Scholar]
  45. McMurray R. W., Allen S. H., Braun A. L., Rodriguez F., Walker S. E. Longstanding hyperprolactinemia associated with systemic lupus erythematosus: possible hormonal stimulation of an autoimmune disease. J Rheumatol. 1994 May;21(5):843–850. [PubMed] [Google Scholar]
  46. Meng C., Lockshin M. Pregnancy in lupus. Curr Opin Rheumatol. 1999 Sep;11(5):348–351. doi: 10.1097/00002281-199909000-00004. [DOI] [PubMed] [Google Scholar]
  47. Mintz G., Niz J., Gutierrez G., Garcia-Alonso A., Karchmer S. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach. J Rheumatol. 1986 Aug;13(4):732–739. [PubMed] [Google Scholar]
  48. Mok C. C., Lau C. S., Tam S. C. Prolactin profile in a cohort of Chinese systemic lupus erythematosus patients. Br J Rheumatol. 1997 Sep;36(9):986–989. doi: 10.1093/rheumatology/36.9.986. [DOI] [PubMed] [Google Scholar]
  49. Mok C. C., Lau C. S., Wong R. W. Risk factors for ovarian failure in patients with systemic lupus erythematosus receiving cyclophosphamide therapy. Arthritis Rheum. 1998 May;41(5):831–837. doi: 10.1002/1529-0131(199805)41:5<831::AID-ART9>3.0.CO;2-1. [DOI] [PubMed] [Google Scholar]
  50. Mok C. C., Wong R. W., Lau C. S. Exacerbation of systemic lupus erythematosus by breast feeding. Lupus. 1998;7(8):569–570. doi: 10.1191/096120398678920550. [DOI] [PubMed] [Google Scholar]
  51. Ninomiya C., Taniguchi O., Kato T., Hirano T., Hashimoto H., Hirose S. Distribution and clinical significance of lupus anticoagulant and anticardiolipin antibody in 349 patients with systemic lupus erythematosus. Intern Med. 1992 Feb;31(2):194–199. doi: 10.2169/internalmedicine.31.194. [DOI] [PubMed] [Google Scholar]
  52. Nossent H. C., Swaak T. J. Systemic lupus erythematosus. VI. Analysis of the interrelationship with pregnancy. J Rheumatol. 1990 Jun;17(6):771–776. [PubMed] [Google Scholar]
  53. Nossent H. C., Swaak T. J. Systemic lupus erythematosus. VI. Analysis of the interrelationship with pregnancy. J Rheumatol. 1990 Jun;17(6):771–776. [PubMed] [Google Scholar]
  54. Ost L., Wettrell G., Björkhem I., Rane A. Prednisolone excretion in human milk. J Pediatr. 1985 Jun;106(6):1008–1011. doi: 10.1016/s0022-3476(85)80259-6. [DOI] [PubMed] [Google Scholar]
  55. Ostendorf B., Fischer R., Santen R., Schmitz-Linneweber B., Specker C., Schneider M. Hyperprolactinemia in systemic lupus erythematosus? Scand J Rheumatol. 1996;25(2):97–102. doi: 10.3109/03009749609069215. [DOI] [PubMed] [Google Scholar]
  56. Out H. J., Bruinse H. W., Christiaens G. C., van Vliet M., de Groot P. G., Nieuwenhuis H. K., Derksen R. H. A prospective, controlled multicenter study on the obstetric risks of pregnant women with antiphospholipid antibodies. Am J Obstet Gynecol. 1992 Jul;167(1):26–32. doi: 10.1016/s0002-9378(11)91619-6. [DOI] [PubMed] [Google Scholar]
  57. Oviasu E., Hicks J., Cameron J. S. The outcome of pregnancy in women with lupus nephritis. Lupus. 1991 Nov;1(1):19–25. doi: 10.1177/096120339100100104. [DOI] [PubMed] [Google Scholar]
  58. PINSKY L., DIGEORGE A. M. CLEFT PALATE IN THE MOUSE: A TERATOGENIC INDEX OF GLUCOCORTICOID POTENCY. Science. 1965 Jan 22;147(3656):402–403. doi: 10.1126/science.147.3656.402. [DOI] [PubMed] [Google Scholar]
  59. Packham D. K., Lam S. S., Nicholls K., Fairley K. F., Kincaid-Smith P. S. Lupus nephritis and pregnancy. Q J Med. 1992 Apr;83(300):315–324. [PubMed] [Google Scholar]
  60. Parke A. L., Rothfield N. F. Antimalarial drugs in pregnancy--the North American experience. Lupus. 1996 Jun;5 (Suppl 1):S67–S69. [PubMed] [Google Scholar]
  61. Parke A., West B. Hydroxychloroquine in pregnant patients with systemic lupus erythematosus. J Rheumatol. 1996 Oct;23(10):1715–1718. [PubMed] [Google Scholar]
  62. Pauzner R., Urowitz M. B., Gladman D. D., Gough J. M. Prolactin in systemic lupus erythematosus. J Rheumatol. 1994 Nov;21(11):2064–2067. [PubMed] [Google Scholar]
  63. Petri M., Howard D., Repke J. Frequency of lupus flare in pregnancy. The Hopkins Lupus Pregnancy Center experience. Arthritis Rheum. 1991 Dec;34(12):1538–1545. doi: 10.1002/art.1780341210. [DOI] [PubMed] [Google Scholar]
  64. Petri M. Pregnancy in SLE. Baillieres Clin Rheumatol. 1998 Aug;12(3):449–476. doi: 10.1016/s0950-3579(98)80030-7. [DOI] [PubMed] [Google Scholar]
  65. Pirson Y., Van Lierde M., Ghysen J., Squifflet J. P., Alexandre G. P., van Ypersele de Strihou C. Retardation of fetal growth in patients receiving immunosuppressive therapy. N Engl J Med. 1985 Aug 1;313(5):328–328. doi: 10.1056/NEJM198508013130516. [DOI] [PubMed] [Google Scholar]
  66. Rahman P., Gladman D. D., Urowitz M. B. Clinical predictors of fetal outcome in systemic lupus erythematosus. J Rheumatol. 1998 Aug;25(8):1526–1530. [PubMed] [Google Scholar]
  67. Rai R., Cohen H., Dave M., Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies) BMJ. 1997 Jan 25;314(7076):253–257. doi: 10.1136/bmj.314.7076.253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Ramsey-Goldman R., Hom D., Deng J. S., Ziegler G. C., Kahl L. E., Steen V. D., LaPorte R. E., Medsger T. A., Jr Anti-SS-A antibodies and fetal outcome in maternal systemic lupus erythematosus. Arthritis Rheum. 1986 Oct;29(10):1269–1273. doi: 10.1002/art.1780291013. [DOI] [PubMed] [Google Scholar]
  69. Ramsey-Goldman R., Mientus J. M., Kutzer J. E., Mulvihill J. J., Medsger T. A., Jr Pregnancy outcome in women with systemic lupus erythematosus treated with immunosuppressive drugs. J Rheumatol. 1993 Jul;20(7):1152–1157. [PubMed] [Google Scholar]
  70. Ramsey-Goldman R., Schilling E. Immunosuppressive drug use during pregnancy. Rheum Dis Clin North Am. 1997 Feb;23(1):149–167. doi: 10.1016/s0889-857x(05)70320-3. [DOI] [PubMed] [Google Scholar]
  71. Reber P. M. Prolactin and immunomodulation. Am J Med. 1993 Dec;95(6):637–644. doi: 10.1016/0002-9343(93)90360-2. [DOI] [PubMed] [Google Scholar]
  72. Ruiz-Irastorza G., Lima F., Alves J., Khamashta M. A., Simpson J., Hughes G. R., Buchanan N. M. Increased rate of lupus flare during pregnancy and the puerperium: a prospective study of 78 pregnancies. Br J Rheumatol. 1996 Feb;35(2):133–138. doi: 10.1093/rheumatology/35.2.133. [DOI] [PubMed] [Google Scholar]
  73. Shaheen F. A., al-Sulaiman M. H., al-Khader A. A. Long-term nephrotoxicity after exposure to cyclosporine in utero. Transplantation. 1993 Jul;56(1):224–225. doi: 10.1097/00007890-199307000-00044. [DOI] [PubMed] [Google Scholar]
  74. Sibai B. M., Gordon T., Thom E., Caritis S. N., Klebanoff M., McNellis D., Paul R. H. Risk factors for preeclampsia in healthy nulliparous women: a prospective multicenter study. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol. 1995 Feb;172(2 Pt 1):642–648. doi: 10.1016/0002-9378(95)90586-3. [DOI] [PubMed] [Google Scholar]
  75. Silver R. K., MacGregor S. N., Sholl J. S., Hobart J. M., Neerhof M. G., Ragin A. Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody-positive obstetric patients. Am J Obstet Gynecol. 1993 Dec;169(6):1411–1417. doi: 10.1016/0002-9378(93)90410-k. [DOI] [PubMed] [Google Scholar]
  76. Tseng C. E., Buyon J. P. Neonatal lupus syndromes. Rheum Dis Clin North Am. 1997 Feb;23(1):31–54. doi: 10.1016/s0889-857x(05)70313-6. [DOI] [PubMed] [Google Scholar]
  77. Turner G., Collins E. Fetal effects of regular salicylate ingestion in pregnancy. Lancet. 1975 Aug 23;2(7930):338–339. doi: 10.1016/s0140-6736(75)92778-6. [DOI] [PubMed] [Google Scholar]
  78. Urowitz M. B., Gladman D. D., Farewell V. T., Stewart J., McDonald J. Lupus and pregnancy studies. Arthritis Rheum. 1993 Oct;36(10):1392–1397. doi: 10.1002/art.1780361011. [DOI] [PubMed] [Google Scholar]
  79. Wallace D. J. Antimalarial agents and lupus. Rheum Dis Clin North Am. 1994 Feb;20(1):243–263. [PubMed] [Google Scholar]
  80. Welsch S., Branch D. W. Antiphospholipid syndrome in pregnancy. Obstetric concerns and treatment. Rheum Dis Clin North Am. 1997 Feb;23(1):71–84. doi: 10.1016/s0889-857x(05)70315-x. [DOI] [PubMed] [Google Scholar]
  81. Wong K. L., Chan F. Y., Lee C. P. Outcome of pregnancy in patients with systemic lupus erythematosus. A prospective study. Arch Intern Med. 1991 Feb;151(2):269–273. [PubMed] [Google Scholar]
  82. Zemlickis D., Lishner M., Erlich R., Koren G. Teratogenicity and carcinogenicity in a twin exposed in utero to cyclophosphamide. Teratog Carcinog Mutagen. 1993;13(3):139–143. doi: 10.1002/tcm.1770130304. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES