Preconception counseling critical in chronically ill. (Adolescents with Lupus, Renal Disease).

MIAMI BEACH -- Adolescent girls with chronic illnesses are in need of extensive preconceptional counseling, but many may not be receiving it, according to a pediatric and adolescent gynecologist.

"I don't see many of these sick girls and that is probably because they are seeing the various specialists to treat their condition, but they're not seeing anyone to specifically address their gynecologic needs," said Dr. Betsy Schroeder, director of the division of pediatric and adolescent gynecology at Allegheny General Hospital in Pittsburgh.

It is precisely because of their chronic illnesses that these girls need special counseling about both the effects of a pregnancy on their health and the effects of their illness on the pregnancy, she said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

"This is probably the area where we can make the greatest difference--in talking to them before they get pregnant," she said in an interview.

Some of the focus of preconceptional counseling may be on avoiding pregnancy at the present time. But some chronically ill teenagers may be eager to have a baby while they are young and in relatively good health. If this is the case, Dr. Schroeder said, it is better that they fully understand what to expect and optimize their health in preparation for conception.

Patients with systemic lupus erythematosus have a 20%-40% chance of symptom exacerbation with pregnancy The fetal survival rate is around 85% if the disease is uncomplicated and not active at the time of conception.

In addition to fetal loss, other possible fetal and neonatal effects are preterm delivery, intrauterine growth retardation, babies that are small for gestational age, transient ...