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Abstract

Systemic autoimmune diseases in pregnancy

Several factors can affect pregnancy or neonatal outcome in women with systemic autoimmune diseases (AD) like SLE: repeated spontaneous pregnancy losses (frequently related to antiphospholipid antibodies), neonatal lupus with complete congenital heart block (linked to transplacental passage of IgG anti Ro/SS-A antibodies) and the disease activity itself that can affect the mother, the pregnancy and fetal outcome. If appropriately managed, the antiphospholipid syndrome is one of the few tractable causes of pregnancy losses. The modern management of pregnancy in patients with AD includes the treatment of disease flares, using drugs effective but safe for fetus. Corticosteroids and some immunosuppressive drugs can be used in pregnancy to control maternal disease. Improvements in disease management and perinatal monitoring have resulted in a significant decrease in pregnancy loss in SLE over the last 40 years and a trend toward decreased preterm deliveries in comparison to the general population. Nevertheless the fetal risk continues to be higher than in pregnancies of healthy women particularly in women with antiphospholipid antibodies. The main problem remains a high rate of prematurity, but without maternal or neonatal death. These improvements highlight the importance of cooperation between rheumatologists, obstetricians and perinatologists. The majority of SLE mothers can sustain pregnancy without detrimental effects, provided that the pregnancy is planned during the inactive phase of the disease.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2015; 11(3): 228–246

Keywords
Autoimmune disease, systemic lupus erythematosus, antiphospholipid syndrome, high-risk pregnancy, fetal loss

Rebecca Fischer-Betz1, Boris Tutschek2
1 Poliklinik für Rheumatologie, Universitätsklinikum Düsseldorf
2 Pränatal Zürich, Ultraschallpraxis, Zürich
Reviewer: Manja Krause, Berlin,
und Christof Specker, Essen

Fischer-Betz R. Systemische ... Gynakol Geburtsmed Gynakol Endokrinol 2015; 11(3): 228–246 publiziert 30.11.2015 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2015 ISSN 1614-8533