Pregnancy and autoimmune diseases
Pregnancy and autoimmune diseases
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DOI：
10.1016/j.berh.2004.02.012
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发表时间：
2004-06-01
影响因子：
5.2
通讯作者：
Gordon, C
中科院分区：
文献类型：
--
作者：
Gordon, C
直到大约15年前，对患有自身免疫性风湿性疾病，特别是系统性红斑狼疮、系统性硬化症和血管综合征的妇女的一般建议是避免怀孕，因为孕妇和胎儿的发病率和死亡率都很高。然而，现在很清楚，这些风险可以通过在疾病活跃时避免怀孕和继续适当的药物治疗来减少怀孕期间疾病发作的机会来降低。本文将回顾这一建议的证据，并考虑在女性试图怀孕之前应该与她们讨论的其他问题。这将包括妊娠对个体自身免疫性疾病的影响，以及疾病和药物治疗对生育和妊娠结局的潜在影响。抗磷脂抗体综合征已成为胎儿流产、先兆子痫和早产的主要原因。此病的临床和实验室诊断将不包括在内，但读者可以参考最近的一篇优秀的综述[Obstet]。妇科杂志。101(2003)1333]。关于妊娠和自身免疫性风湿病的大部分数据来自回顾性分析，但在过去10年里也有一些前瞻性研究的报道。很少有荟萃分析或随机临床试验。
Until about 15 years ago, the general advice to women with autoimmune rheumatic diseases, especially systemic lupus erythematosus, systemic sclerosis and vasculitic syndromes, was to avoid pregnancy as there was a high risk of maternal and fetal morbidity and mortality. However, it is now clear that these risks can be reduced in general by avoiding pregnancy when the diseases are active and continuing appropriate medication to reduce the chances of disease flare during pregnancy. This article will review the evidence for this advice and will also consider other issues that should be discussed with women before they attempt to become pregnant. This will include the influence of pregnancy on the individual autoimmune diseases, as well as the potential impact of the diseases and drug therapy on fertility and pregnancy outcomes. Anti-phospholipid antibody syndrome has emerged as a major cause of fetal loss, pre-eclampsia and premature birth. The clinical and laboratory diagnosis of this condition will not be covered, but the reader is referred to an excellent recent review [Obstet. Gynecol. 101 (2003) 1333]. Much of the data on pregnancy and autoimmune rheumatic diseases come from retrospective analyses, but some prospective studies have been reported over the past 10 years. There have been very few meta-analyses or randomized clinical trials.