Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Brescia, Italy.
Autoimmun Rev. 2010 Nov;10(1):51-4. doi: 10.1016/j.autrev.2010.08.004. Epub 2010 Aug 6.
Rheumatic diseases can affect women during their childbearing age. Therefore, physicians should introduce a discussion with the patients about pregnancy and its problems. Lupus pregnancies can be successful, even in patients with renal disease, when planned in remission state; the use of low dose aspirin was shown to be an independent predictor of good outcome, so it can be suggested as a preventive measure. Pregnancies in women with Antiphospholipid Syndrome can fail even if properly treated, especially when associated with a systemic autoimmune disease, a history of both thrombosis and pregnancy morbidity, and a triple positivity of antiphospholipid antibody assays. Women with systemic sclerosis have generally a good obstetric outcome, except for an increase rate of preterm deliveries. Severe disease complications were sometimes reported, but their relationship with gestation is not clear yet. Although data on human pregnancy are still preliminary, anti-TNF agents are classified as non teratogens in contrast to methotrexate and leflunomide. So women affected by aggressive chronic arthritis may be treated with anti-TNF in the pre-conceptional period, discontinuing the drug as soon as pregnancy starts. In order to increase maternal compliance and cope with difficult cases, a multidisciplinary team (rheumatologists/internists, obstetricians and neonatologists) should take care of patients during pregnancy.
风湿性疾病可在女性生育年龄期间影响她们。因此，医生应与患者讨论妊娠及其问题。狼疮妊娠在计划缓解期时可以成功，即使患者有肾脏疾病；低剂量阿司匹林的使用被证明是良好结局的独立预测因素，因此可以作为预防措施建议。即使得到适当治疗，抗磷脂抗体综合征患者的妊娠也可能失败，尤其是当伴有系统性自身免疫性疾病、血栓形成和妊娠发病史以及抗磷脂抗体检测呈三阳性时。系统性硬化症患者的产科结局通常较好，但早产率增加。尽管有时会报告严重的疾病并发症，但它们与妊娠的关系尚不清楚。虽然关于人类妊娠的数据仍不充分，但与甲氨蝶呤和来氟米特相比，抗 TNF 药物被归类为非致畸剂。因此，患有侵袭性慢性关节炎的女性可能在受孕前接受抗 TNF 治疗，一旦怀孕就停止使用该药物。为了提高产妇的依从性并应对困难病例，多学科团队（风湿病学家/内科医生、妇产科医生和新生儿科医生）应在妊娠期间照顾患者。
