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NEW YORK (Reuters Health) May 17 - Contrary to previous belief,
serum estrogen and progesterone levels in pregnant patients with
systemic lupus erythematosus (SLE) do not increase during the second
and third trimesters, according to Italian researchers.
Dr. Andrea Doria, of the University of Padua in Padua,
and colleagues studied 17 consecutive pregnant SLE patients and
8 healthy pregnant matched controls. The findings appeared in the
April 15th issue of Arthritis and Rheumatism.
The researchers found a significant variation in disease
activity during pregnancy and postpartum. Disease scores decreased
in the third trimester but increased in the second trimester and
postpartum.
Serum steroid levels varied significantly during pregnancy
in both patients and controls. However, compared with controls,
concentrations of estradiol, progesterone, and dehydroepiandrosterone
sulfate were significantly reduced in those with SLE.
The major observed alteration, however, Dr. Doria
told Reuters Health, was "an unexpected lack of estrogen and progesterone
serum level increase during the second and--even more--the third
trimester of gestation without any changes in the other steroid
hormone levels."
Because "estrogens seem to be mainly implicated as
major enhancers of the immune response, whereas androgens seem to
act as natural suppressors, the estrogen/androgen balance variation...may
result in a lower immune response activation and could account for
the decrease in the disease activity during the third trimester,"
Dr. Doria said.
In an accompanying editorial, Dr. Robert W. McMurray,
of the University of Mississippi, Jackson, points out that "this
inverse relationship challenges the traditional thinking that" increased
estrogen or progesterone concentrations "directly stimulate SLE
autoimmune responses."
As with most novel research, he adds, the results
"raise more questions than they answer."
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