Pre-Conception Disease Activity Assessment
Quiescent disease before pregnancy predicts far better maternal and fetal outcomes.
- 6 mo: Ideal quiescence window (stable disease before conception)
- ~60%: Flare risk if active (placeholder estimate)
- ~10%: Flare risk if quiescent (placeholder estimate)
- C3/C4, dsDNA: Key labs (placeholder monitoring panel)
Why timing conception matters
Placeholder: counseling should target disease quiescence before pregnancy is attempted.
Placeholder callout: pre-conception planning is the single strongest predictor of outcome.
Antiphospholipid Syndrome Risk Screening
Antiphospholipid antibodies raise risk of clotting and pregnancy loss.
- tested: Lupus anticoagulant (placeholder screening marker)
- tested: Anticardiolipin IgG/IgM (placeholder screening marker)
- tested: Anti-β2GPI (placeholder screening marker)
- highest: Triple-positive risk (placeholder risk tier)
Antibody panel and thrombosis risk
Placeholder: triple antibody positivity carries the greatest obstetric risk.
Placeholder callout: aspirin plus heparin is standard for obstetric APS.
Flare Risk During Pregnancy
Pregnancy itself can trigger lupus flares, especially with active baseline disease.
- 2nd/3rd: Flares by trimester (placeholder peak timing)
- continued: Hydroxychloroquine (placeholder safe therapy)
- overlap: Flare vs preeclampsia (placeholder distinction challenge)
- monthly: Monitoring interval (placeholder visit cadence)
Distinguishing flare from preeclampsia
Placeholder: complement and dsDNA trends help separate flare from preeclampsia.
Placeholder callout: continue hydroxychloroquine throughout pregnancy.
Anti-Ro/SSA Antibody Placental Transfer
Maternal Ro/SSA antibodies actively cross the placenta in the second trimester.
- ~16-18 wk: Transfer onset (placeholder gestational window)
- IgG: Antibody class (placeholder active transport)
- ~30%: Ro/SSA prevalence (placeholder SLE cohort estimate)
- Anti-La/SSB: Overlap antibody (placeholder co-occurring marker)
Mechanism of transplacental transfer
Placeholder: FcRn-mediated transport carries maternal IgG into fetal circulation.
Placeholder callout: transfer timing defines the fetal surveillance window.
Neonatal Lupus and Heart Block Monitoring
Serial fetal echocardiograms detect conduction injury before irreversible heart block.
- ~2%: Heart block risk (placeholder first pregnancy estimate)
- ~15-20%: Recurrence risk (placeholder subsequent pregnancy)
- 16-26 wk: Echo screening window (placeholder surveillance period)
- both monitored: Skin/cardiac lupus (placeholder neonatal manifestations)
Surveillance and intervention window
Placeholder: weekly echo during the risk window can catch early first-degree block.
Placeholder callout: complete heart block is usually irreversible once established.