Khamashta M A, Hughes G R
Lupus Research Unit, Rayne Institute, St. Thomas' Hospital, London, UK.
Curr Opin Rheumatol. 1996 Sep;8(5):424-9. doi: 10.1097/00002281-199609000-00006.
Fertility is usually normal in systemic lupus erythematosus. However, cyclophosphamide therapy has been associated with an increased risk for sustained amenorrhea in these patients. There is still debate as to whether pregnancy increases systemic lupus erythematosus activity. We have known for decades that systemic lupus erythematosus is associated with an increased risk for pregnancy loss. Now we know that most excess fetal loss in women with systemic lupus erythematosus occurs in association with antiphospholipid antibodies, which also are associated with pregnancy loss in otherwise healthy women. Prematurity, intrauterine growth retardation, and preeclampsia are common features of lupus pregnancy, especially in women with antiphospholipid antibodies. Pregnancy complicated by antiphospholipid syndrome requires expert care and a team approach involving obstetricians, obstetric physicians, rheumatologists, and clinical hematologists. Treatment and close monitoring including uterine artery Doppler scans and timely delivery may improve fetal outcome in these cases. Although there is no evidence that maternal prednisone should be used prophylactically, fluorinated steroids may be efficacious after in utero identification of congenital heart block, especially in fetuses with associated myocarditis.
系统性红斑狼疮患者的生育能力通常正常。然而，环磷酰胺治疗与这些患者持续闭经风险增加有关。关于妊娠是否会增加系统性红斑狼疮的活动度仍存在争议。几十年来我们都知道，系统性红斑狼疮与流产风险增加有关。现在我们知道，系统性红斑狼疮女性的大多数额外胎儿丢失与抗磷脂抗体有关，而在其他健康女性中，抗磷脂抗体也与流产有关。早产、胎儿宫内生长受限和先兆子痫是狼疮妊娠的常见特征，尤其是在有抗磷脂抗体的女性中。抗磷脂综合征合并妊娠需要专业护理以及由产科医生、产科医师、风湿病学家和临床血液学家组成的团队协作。治疗和密切监测，包括子宫动脉多普勒扫描和适时分娩，可能会改善这些病例的胎儿结局。虽然没有证据表明应预防性使用母体泼尼松，但在子宫内确诊先天性心脏传导阻滞后，尤其是伴有心肌炎的胎儿，氟化类固醇可能有效。
