Canti Valentina, Scarrone Margherita, De Lorenzo Rebecca, Ramirez Giuseppe A, Erra Roberta, Bordoli Sara, Cella Sara, Schmit Elena, Rosa Susanna, Castiglioni Maria T, Rovere-Querini Patrizia
Unit of Internal Medicine, Division of Immunology, Transplantation and Infectious diseases, IRCCS Ospedale San Raffaele, Milan, Italy.
Università Vita-Salute San Raffaele, Milan, Italy.
Immunol Med. 2021 Sep;44(3):204-210. doi: 10.1080/25785826.2020.1868652. Epub 2021 Jan 8.
Systemic lupus erythematosus (SLE) preferentially affects women of childbearing age. Miscarriages or fetal death, intrauterine growth restriction (IUGR), preterm delivery, preeclampsia and disease flares complicate pregnancy in SLE patients. Treatment is challenging due to the need to prevent disease exacerbations and limit obstetrical complications, while showing an acceptable safety profile for both the mother and the fetus. We collected data from 74 pregnancies in 53 SLE patients prospectively followed in a dedicated 'Pregnancy at risk' outpatient clinic from 2003 to 2019. Out of 74, 45 pregnancies patients were treated with hydroxychloroquine (HCQ). Mothers under HCQ therapy (HCQ patients) and those who did not receive HCQ (HCQ) were homogeneous in terms of age and comorbidities. Disease activity prior to conception was slightly higher in HCQ patients. No significant difference was observed in terms of obstetrical history. In patients achieving a viable pregnancy, the rate of IUGR (4/39, 10% in HCQ vs 8/25, 32%, in HCQ patients, < .05) was significantly lower in HCQ patients. Conversely, HCQ patients displayed a significantly longer time to delivery (37.8 ± 1.72 vs. 36.3 ± 4.11 in HCQ patients, < .05). HCQ is safe in pregnant patients with SLE and protects against obstetrical complications.
系统性红斑狼疮（SLE）在育龄女性中更为常见。流产、死胎、胎儿生长受限（IUGR）、早产、子痫前期和疾病发作会使SLE患者的妊娠情况复杂化。由于需要预防疾病加重并限制产科并发症，同时要确保对母亲和胎儿都有可接受的安全性，因此治疗具有挑战性。我们收集了2003年至2019年在专门的“高危妊娠”门诊前瞻性随访的53例SLE患者的74次妊娠数据。在74例患者中，45例妊娠患者接受了羟氯喹（HCQ）治疗。接受HCQ治疗的母亲（HCQ患者）和未接受HCQ治疗的母亲在年龄和合并症方面具有同质性。受孕前的疾病活动度在HCQ患者中略高。产科病史方面未观察到显著差异。在成功妊娠的患者中，HCQ患者的IUGR发生率（4/39，10%；而未接受HCQ治疗的患者为8/25，32%，P<0.05）显著较低。相反，HCQ患者的分娩时间显著更长（37.8±1.72周 vs. 未接受HCQ治疗的患者为36.3±4.11周，P<0.05）。HCQ对患有SLE的孕妇是安全的，并可预防产科并发症。
