Dalal Deepan S, Patel Khyati A, Patel Madhuri A
1Department of Medicine, Division of Rheumatology, Brown University Warren Alpert Medical School, 375 Wampanoag Trail, #302C, East Providence, RI 02915 USA.
The Department of Obstetrics and Gynecology, Nowrosjee Wadia Maternity Hospital, Mumbai, India.
J Obstet Gynaecol India. 2019 Apr;69(2):104-109. doi: 10.1007/s13224-019-01212-8. Epub 2019 Mar 12.
Systemic lupus erythematosus is a chronic multisystemic autoimmune disease that predominantly affects young women of childbearing age group. There is a complex immunologic interplay during pregnancy in patients with systemic lupus erythematosus. The pregnancy has direct impact on the disease where an increased rate of flares is noted, and lupus leads to increased risk of hypertensive diseases of pregnancy, preterm birth as well as miscarriages, particularly those with antiphospholipid antibodies. Neonates born to patients with lupus are at increased risk of neonatal lupus as well as heart block if born to patients with positive SSA/SSB. Despite the increased risk of morbidity, recent data suggest improved outcomes in pregnant patients with lupus. A multidisciplinary approach with careful monitoring of pregnancy and lupus could reduce adverse outcomes in these patients. This requires careful pregnancy planning, defining the clinical and serologic involvement of lupus, careful monitoring the patient for adverse pregnancy outcome as well as lupus flares and comprehensive understanding of the drugs that can be safely used in pregnancy. Fetuses should be carefully monitored for heart and neonates for neonatal lupus. Hydroxychloroquine, azathioprine and corticosteroids can be used during pregnancy and may reduce the risk of adverse outcomes. Similarly, appropriate therapy needs to be instituted for hypertensive diseases in pregnancy. Anticoagulant therapy may be necessary for patients with antiphospholipid syndrome.
系统性红斑狼疮是一种慢性多系统自身免疫性疾病，主要影响育龄期年轻女性。系统性红斑狼疮患者在孕期存在复杂的免疫相互作用。妊娠对疾病有直接影响，表现为病情复发率增加，而狼疮会导致妊娠高血压疾病、早产以及流产的风险增加，尤其是那些伴有抗磷脂抗体的患者。狼疮患者所生的新生儿患新生儿狼疮的风险增加，如果母亲抗SSA/SSB阳性，新生儿患心脏传导阻滞的风险也会增加。尽管发病风险增加，但近期数据表明狼疮孕妇的结局有所改善。采用多学科方法，仔细监测妊娠和狼疮情况，可以降低这些患者的不良结局。这需要精心的妊娠计划，明确狼疮的临床和血清学表现，密切监测患者有无不良妊娠结局以及狼疮病情复发，并全面了解孕期可安全使用的药物。应仔细监测胎儿的心脏情况，新生儿则需监测是否患新生儿狼疮。羟氯喹、硫唑嘌呤和皮质类固醇可在孕期使用，可能会降低不良结局的风险。同样，对于妊娠高血压疾病需要采取适当的治疗措施。抗磷脂综合征患者可能需要抗凝治疗。
