Prévot A, Martini S, Guignard J P
Service de pédiatrie, Unité de néphrologie, CHUV, Lausanne.
Rev Med Suisse Romande. 2001 Apr;121(4):283-91.
The number of pregnant women receiving immunosuppressive therapy is increasing. Use of immunosuppressants during pregnancy is indicated for anti-rejection therapy in transplantation patients and treatment of autoimmune diseases. Despite the maternal and fetal risks of these pregnancies, the proportion of surviving infants is improving and the possibility that a pregnancy could occur in these women during their childbearing years should be considered. All immunosuppressant drugs and their metabolites cross the placenta, raising questions about the long-term outcome of the children exposed to these agents in utera. There is no increased risk of congenital anomalies. However, there is an elevated incidence of prematurity, intrauterine growth retardation (IUGR) and therefore low birthweight, as well as maternal hypertension and preeclampsia. The most frequent neonatal complications are those associated with prematurity and IUGR, as well as adrenal insufficiency with corticosteroids, immunological disturbances with azathioprine and cyclosporin, and hyperkalemia with tacrolimus. The long-term follow-up of infants exposed to immunosuppressants in utero is still limited and experimental studies raise the question whether there could be an increased incidence at adult age of some pathologies including renal insufficiency, hypertension and diabetes. The follow-up of these infants should be carefully organized and multidisciplinary, taking the perinatal context into account.
接受免疫抑制治疗的孕妇数量正在增加。孕期使用免疫抑制剂适用于移植患者的抗排斥治疗以及自身免疫性疾病的治疗。尽管这些妊娠存在母婴风险，但存活婴儿的比例正在提高，并且应考虑这些女性在育龄期怀孕的可能性。所有免疫抑制药物及其代谢产物都会穿过胎盘，这引发了关于子宫内接触这些药物的儿童长期结局的问题。先天性异常的风险并未增加。然而，早产、宫内生长受限（IUGR）以及由此导致的低出生体重的发生率有所上升，同时还有孕妇高血压和先兆子痫。最常见的新生儿并发症是与早产和IUGR相关的并发症，以及使用皮质类固醇导致的肾上腺功能不全、使用硫唑嘌呤和环孢素导致的免疫紊乱，以及使用他克莫司导致的高钾血症。子宫内接触免疫抑制剂的婴儿的长期随访仍然有限，实验研究提出了一个问题，即在成年期某些疾病（包括肾功能不全、高血压和糖尿病）的发病率是否会增加。对这些婴儿的随访应精心组织且具有多学科性，并考虑围产期情况。
