Systemic lupus erythematosus and pregnancy
Systemic lupus erythematosus and pregnancy
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DOI：
10.1016/j.berh.2006.04.003
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发表时间：
2006-08-01
影响因子：
5.2
通讯作者：
Khamashta, Munther A.
中科院分区：
文献类型：
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作者：
Khamashta, Munther A.
患有系统性红斑狼疮（SLE）的妇女在开始怀孕时面临重大风险，但参加由经验丰富的团队组成的多学科诊所可以改善妇女及其婴儿的妊娠结局。SLE患者的妊娠应在怀孕前与患者充分协商后制定计划和管理策略。怀孕会增加狼疮发作的可能性。无法预测个体患者何时或是否会发作，但如果疾病在怀孕6个月内活跃，发作的可能性更大。妊娠期蛋白尿恶化可能预示狼疮发作，但鉴别诊断也包括对妊娠和先兆子痫的生理反应。皮质类固醇、羟氯喹和硫唑嘌呤在妊娠期使用是安全的，尽管有多年的使用经验，但没有不良胎儿效应的报道。正确识别抗磷脂综合征患者是很重要的，因为在怀孕期间治疗受影响的妇女可以改善胎儿和母亲的结局。新生儿SLE虽然罕见，但当胎儿心脏为靶器官时，其死亡率和发病率很高。预防性治疗，包括静脉注射免疫球蛋白治疗，有待更大规模的试验。
Women with systemic lupus erythematosus (SLE) face significant risks when embarking on a pregnancy, but attending a multidisciplinary clinic staffed by an experienced team can improve pregnancy outcome for women and their babies. Pregnancy in SLE should be planned and a management strategy should be agreed in full consultation with the patient, prior to conception. Pregnancy increases the likelihood of a lupus flare. It is not possible to predict when, or if, an individual patient will flare, although flare is more likely if disease has been active within 6 months of conception. Worsening of proteinuria in pregnancy could herald a lupus flare, but the differential diagnosis also includes the physiological response to pregnancy and pre-eclampsia. Corticosteroids, hydroxychloroquine and azathioprine are safe to use in pregnancy, with no adverse fetal effects reported despite many years of experience with their use. Correct identification of patients with antiphospholipid syndrome is important because treatment of affected women during pregnancy can improve fetal and maternal outcome.Neonatal SLE, although rare, carries a significant mortality and morbidity when the fetal heart is the targeted organ. Prophylaxis therapies, including treatment with intravenous immunoglobulin, await larger trials.