We are writing in response to a letter by Scarpinato1 that appeared in the May 8, 1995, issue of the Archives.
We thank Scarpinato for his interest in our article, "Preconceptional Counseling and Intervention."2 He states that we did not specifically discuss connective tissue diseases at length in our article; we recognize this. The effects of pregnancy on a variety of medical diseases and, contrastingly, medical diseases on pregnancy were beyond the scope of our article. While pregnancy does not usually increase the incidence of major manifestations of systemic lupus erythematosus, a woman who has systemic lupus erythematosus has a higher risk of pregnancy complications than one who does not. These risks are even more significant with concomitant hypertension or renal disease.3
Scarpinato mentions the category of preeclampsia and hypertensive disorders of pregnancy and preconceptional counseling to decrease the risk of disease. The issue of low-dose aspirin