Center for Rheumatic Diseases, Yokohama City University Medical Center, 4-57 Urafune-cho, Yokohama, Kanagawa 232-0024, Japan.
Clin Rev Allergy Immunol. 2013 Feb;44(1):57-64. doi: 10.1007/s12016-011-8269-8.
Systemic lupus erythematosus (SLE) is mainly a disease of fertile women and the coexistence of pregnancy is by no means a rare event. How SLE and its treatment affect pregnancy outcomes is still a matter of debate. We performed a retrospective analysis of 41 SLE patients (55 pregnancies) who were followed at our university hospital from January 2000 to December 2009. The mean age of patients was 30.6±4.8 years and mean disease duration was 6.6±5.3 years. After exclusion of artificial abortions, live birth rate was 84%. Significantly, more women with stillbirth pregnancies were complicated with antiphospholipid syndrome (APS) than women with live birth pregnancies (two of eight stillbirth pregnancies (25%) versus one of 42 live birth pregnancies (2%); p=0.014) and hypocomplementemia at conception (four of eight stillbirth pregnancies (50%) versus six of 42 live birth pregnancies (14%); p=0.021). Compared with nonrenal pregnancies, renal pregnancies were younger at SLE disease onset, had a lower positivity of anti-RNP antibody, and were more complicated with pregnancy-induced hypertension. Past maximum dose of prednisolone, the dose of prednisolone at conception, and percentage of past steroid pulse therapy were higher in renal pregnancies. Outcomes of pregnancies were not significantly different both for mothers and for infants between renal and nonrenal pregnancies. We conclude that it is necessary to provide SLE mothers with the proper information before pregnancy. Women with APS or hypocomplementemia should be regarded with particular attention. Optimal management of mothers and infants requires collaborative efforts of rheumatologists and obstetricians.
系统性红斑狼疮（SLE）主要发生在生育期妇女，妊娠合并 SLE 并非罕见。SLE 及其治疗对妊娠结局的影响仍存在争议。我们对 2000 年 1 月至 2009 年 12 月在我院就诊的 41 例（55 次妊娠）SLE 患者进行了回顾性分析。患者平均年龄为 30.6±4.8 岁，平均病程为 6.6±5.3 年。排除人工流产后，活产率为 84%。值得注意的是，死胎妊娠患者中发生抗磷脂综合征（APS）的比例明显高于活产妊娠患者（8 例死胎妊娠中有 2 例[25%]，42 例活产妊娠中有 1 例[2%]；p=0.014）和受孕时低补体血症（8 例死胎妊娠中有 4 例[50%]，42 例活产妊娠中有 6 例[14%]；p=0.021）。与非肾脏妊娠相比，肾脏妊娠患者 SLE 发病年龄更小，抗 RNP 抗体阳性率更低，且更易并发妊娠高血压。肾脏妊娠患者过去泼尼松最大剂量、受孕时泼尼松剂量和过去激素冲击治疗比例更高。肾脏妊娠和非肾脏妊娠母亲和婴儿的妊娠结局均无显著差异。我们的结论是，有必要在妊娠前为 SLE 母亲提供适当的信息。对于 APS 或低补体血症患者应给予特别关注。母亲和婴儿的最佳管理需要风湿病学家和妇产科医生的共同努力。
