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2 Lupus Anticoagulant-AnticardiolipinAntiphospholipid Antibody Syndrome
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The presence of antibodies to phospholipids and a variety of clinical symptoms, including vascular thromboses, thrombocytopenia, and recurrent pregnancy loss, characterize the lupus anticoagulant-anticardiolipin-antiphospholipid antibody syndrome Many of these patients have systemic lupus erythematosus like symptoms but do not meet specific diagnostic criteria for that disease The lupus anticoagulant and anticardiolipin antibody may occur in these patients, and both may cause arterial and venous thromboses Detection of these antiphospholipid antibodies may require a combination of laboratory tests The lupus anticoagulant will prolong both the partial thromboplastin time and the Russell viper venom time The latter is a more sensitive predictor of disease Such patients should also be screened for the presence of the factor V Leiden mutation Anticardiolipin antibody may be detected with enzyme-linked immunosorbent assay (ELISA) testing Either antibody may cause false-positive serologic tests for syphilis This syndrome may require treatment with anticoagulant medications In a small number of patients with recurrent pregnancy loss and a diagnosis of lupus anticoagulant syndrome, improved outcomes have been reported following treatment with heparin anticoagulation (8000 20,000 units in two or three doses daily) or low-molecularweight heparin (1 mg/kg twice daily) and low-dose aspirin begun before or early in pregnancy and continued until the postpartum period The addition of monthly infusions of intravenous immunoglobulin to this regimen did not improve outcomes in such patients
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Empson M et al Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant Cochrane Database Syst Rev 2005 Apr 18;(2):CD002859 [PMID: 15846641] Petri M et al Management of antiphospholipid syndrome in pregnancy Rheum Dis Clin North Am 2006 Aug;32(3):591 607 [PMID: 16880086]
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B Folic Acid Deficiency Anemia
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Folic acid deficiency anemia is the main cause of macrocytic anemia in pregnancy, since vitamin B12 deficiency anemia is rare in the childbearing years The daily requirement of folic acid doubles from 04 mg to 08 mg in pregnancy Twin pregnancies, infections, malabsorption, and use of anticonvulsant drugs such as phenytoin can precipitate folic acid deficiency The anemia may first be seen in the puerperium owing to the increased need for folate during lactation The diagnosis is made by finding macrocytic red cells and hypersegmented neutrophils in a blood smear (see 13) However, blood smears in pregnancy may be difficult to interpret, since they frequently show iron deficiency changes as well Because the deficiency is hard to diagnose and folate intake is inadequate in some socioeconomic groups, 08 1 mg of oral folic acid is given as a supplement in pregnancy; the dose in established deficiency is 1 5 mg/d Good sources of folate in food are leafy green vegetables, orange juice, peanuts, and beans Cooking and storage of food destroy folic acid Strict vegetarians who eat no eggs or milk products should take vitamin B12 supplements during pregnancy and lactation
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C Sickle Cell Anemia
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Women with sickle cell anemia are subject to serious complications in pregnancy The anemia becomes more severe, and crises may occur more frequently Complications include infections, bone pain, pulmonary infarction, congestive heart failure, and preeclampsia There is an increased rate of spontaneous abortion and higher maternal and perinatal mortality rates Intensive medical treatment may improve the outcome for mother and fetus Frequent indicated transfusions of packed cells or leuko-
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3 Asthma
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The effect of pregnancy on asthma is unpredictable About 50% of patients have no change, 25% improve, and 25% get worse Management of acute and chronic asthma during pregnancy does not differ significantly from that of nonpregnant women The goal is to maintain maternal PO2 > 80 mm Hg to sustain normal fetal oxygenation (see 9)
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Namazy JA et al Current guidelines for the management of asthma during pregnancy Immunol Allergy Clin North Am 2006 Feb;26(1):93 102 [PMID: 16443145]
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