a Department of Rheumatology , Hospital Universitário, Universidade Federal de Juiz de Fora , Juiz de Fora , MG , Brazil.
b College of Medicine , Florida State University , Daytona Beach , FL , USA.
Expert Rev Clin Immunol. 2019 Jan;15(1):27-39. doi: 10.1080/1744666X.2019.1541739. Epub 2018 Nov 5.
: Since most of the autoimmune diseases (AID) affect mostly women in their fertile years, and fertility is in general preserved, the use of disease-modifying antirheumatic drugs (DMARDs) during conception, pregnancy, and lactation has been a matter of concern in the treatment of women affected by AID. : We performed a comprehensive review of the latest and most relevant research papers published in the field and discussed different aspects related to the use of synthetic and biologic DMARDs and immunosuppressants in the preconceptional period, during pregnancy and lactation in AID patients, both in males and females. : Active AID impose an increased risk for adverse maternal and fetal outcomes, such as preeclampsia, miscarriage, intrauterine growth restriction, prematurity, low birth weight, and stillbirth. Family planning with proper contraception and shared decision-making on the ideal time to conceive with treatment adjustment must be a rule. One of the main challenges when counseling and/or adjusting treatment of patients that are planning a pregnancy is to provide a medication that is at the same time efficacious and safe at the conceptional period and to developing the fetus.
由于大多数自身免疫性疾病（AID）在育龄期主要影响女性，且生育能力通常得以保留，因此在受孕、妊娠和哺乳期使用疾病修正抗风湿药物（DMARDs）一直是治疗 AID 女性患者的关注焦点。我们对该领域最新和最相关的研究论文进行了全面回顾，并讨论了男性和女性 AID 患者在受孕前、妊娠和哺乳期使用合成和生物 DMARDs 和免疫抑制剂的不同方面。活动期 AID 会增加母婴不良结局的风险，如子痫前期、流产、宫内生长受限、早产、低出生体重和死产。应通过适当的避孕进行计划生育，并就调整治疗以选择理想的受孕时间做出共同决策。当对计划怀孕的患者进行咨询和/或调整治疗时，主要挑战之一是提供一种在受孕期既有效又安全的药物，同时对胎儿发育无影响。
