Department of Rheumatology, National Center of Pregnancy and Rheumatic Disease, University Hospital of Trondheim, Trondheim, Norway.
Curr Opin Rheumatol. 2013 Sep;25(5):591-6. doi: 10.1097/BOR.0b013e328363ebf7.
In spite of the advances made in the management of pregnancies in women with systemic lupus erythematosus (SLE), maternal complications and adverse fetal outcomes still exceed the rate of pregnancy complications in the general population. An intriguing question relates to the observation that pregnancy loss, intrauterine growth restriction (IUGR), preterm birth, and preeclampsia remain major complications in SLE pregnancies, not substantially altered by improved therapy and monitoring.
From the review of the recent literature on the pathogenesis of pregnancy loss, IUGR, preeclampsia, and prematurity, it appears that clinical or subclinical inflammation, presence of autoantibodies, hormonal dysfunction, and immune alterations of lupus contribute to pregnancy complications. Impairment of early placenta development leads to poor vascularization, resulting in placental ischemia and subsequent endothelial damage. Depending on the extent of the pathological process, pregnancy loss, IUGR, and preeclampsia can develop.
Early recognition of pregnancy complications is desirable in order to prevent their development or to prompt intervention that improves the outcomes. Several biomarkers have been investigated for their ability to predict complications at an early stage of pregnancy. However, up to date only lupus anticoagulant has emerged as a consistent predictor for adverse pregnancy outcomes.
尽管系统性红斑狼疮（SLE）女性妊娠管理已有进展，但母体并发症和不良胎儿结局仍高于普通人群妊娠并发症发生率。一个有趣的问题是，观察到妊娠丢失、宫内生长受限（IUGR）、早产和子痫前期仍然是 SLE 妊娠的主要并发症，尽管治疗和监测有所改善，但并未明显改变。
从对妊娠丢失、IUGR、子痫前期和早产发病机制的最新文献复习中，似乎临床或亚临床炎症、自身抗体存在、激素功能障碍和狼疮免疫改变都与妊娠并发症有关。早期胎盘发育不良导致血管化不良，导致胎盘缺血和随后的内皮损伤。根据病理过程的程度，可能会发生妊娠丢失、IUGR 和子痫前期。
早期识别妊娠并发症是可取的，以便预防其发生或及时干预以改善结局。已经研究了几种生物标志物来预测妊娠早期的并发症。然而，迄今为止，只有狼疮抗凝剂已被证明是不良妊娠结局的一致预测因子。
