How safe pregnancy in women with lupus erythematosus

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2016-08-16 20:35 source: DXY Author: Li Wenjunfont size-|+Systemic lupus erythematosus (LE) is more common in women of childbearing age, if

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2016-08-16 20:35 source: DXY Author: Li Wenjun

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Systemic lupus erythematosus (LE) is more common in women of childbearing age, if the patient is pregnant, the disease itself and the drug will have an impact on maternal and infant, so LE pregnant patients must undergo multidisciplinary consultation according to the specific circumstances of specified pregnancy plan, in order to minimize the impact.

G. Guettrot-Imbert professor of medicine from the leading French University of Paris 5 hospital Cochin team of the French LE patients currently pregnant management methods were summarized, and the article will be published in a recent Annales de Dermatologie et de v n r ologie magazine.

Xiao Bian will be more important in the compilation of the following, we want to help.

Contraceptive drugs

The first thing to say is that LE patients with contraceptive drugs. LE is divided into two categories, one is systemic lupus erythematosus (SLE), a class of skin lupus erythematosus, both hazards are different, there are differences between treatment. For the use of estrogen containing contraceptives can be used in the LE controversy, some people think that estrogen can aggravate the condition of LE, but the lack of sufficient evidence. The conservative view that estrogen containing contraceptives for resting and no thrombosis, antiphospholipid syndrome (APS) patients with SLE and antinuclear antibodies, antiphospholipid antibody negative skin in patients with systemic lupus erythematosus.

Progesterone alone is more safe for LE. Chlormadinone and cyproterone acetate is commonly used drugs, side effects including menstrual disorders, irregular bleeding, bleeding or amenorrhea, not serious. Nomegestrol norpregnane derivatives are not recommended for use in LE. Because of the increased risk of venous thrombosis, medroxyprogesterone is not used in LE.

Desogestrel and levonorgestrel is France's largest amount of progestin only pills, whether oral, subcutaneous or embedded intrauterine implantation, have good safety for patients with LE, the side effects of menstrual disorders, irregular bleeding etc..

Contraindication of pregnancy

The purpose of preconception counseling is clear of pregnancy contraindication, including LE activity, pulmonary hypertension, uncontrolled hypertension and low tolerance heart valvular disease. Creatinine clearance rate of less than 40 ml/min is a relative contraindication, the need for internal medicine treatment. Factors affecting maternal and child health include: SLE activity in the first half of pregnancy into the active period, the amount of glucocorticoids more than 10 mg/d, organ failure, hypertension, APS, anti SSA antibody positive / anti SSB antibody positive.

When conditions allow pregnancy, to begin to stop the impact of maternal and child health during pregnancy and the use of nutritional supplements. If used methotrexate patients must use folic acid, corticosteroids, warfarin and risk of preeclampsia pregnant women need calcium and vitamin D supplement.

The interaction between pregnancy and LE

SLE activity in the second half of pregnancy can lead to SLE re-enter the active period. The history of lupus nephritis is also easy to stimulate SLE activity due to pregnancy.

The mortality rate of SLE patients was 20 times higher than that of the general population, and the main causes of death were SLE activity, preeclampsia, APS and side effects of anti SLE drugs.

The incidence of pre eclampsia in patients with LE was increased by 30%, and the only way to deal with it was to terminate pregnancy.

LE can lead to fetal intrauterine growth retardation, premature birth, stillbirth.

Anti SSA antibody and anti SSB antibody can cause infant lupus erythematosus, the main symptoms are skin lesions that can be self-healing, but a small part of the baby can be caused by congenital atrioventricular block, the disease mortality rate of about 17%, treatment for pacemaker.

Effect of APS on pregnancy

Diagnostic criteria for APS

Clinical: 1 arterial or venous thrombosis; 2 more than 10 weeks of normal fetal appearance of unknown causes of death; or preeclampsia / placental insufficiency leads to the appearance of premature abortion Fetal Normal; 10 weeks ago or 3 consecutive unexplained.

Laboratory: 1 lupus anticoagulant positive 2; anticardiolipin antibody; anti beta 2 glycoprotein antibody positive 3.

The incidence of preeclampsia in patients with APS is increased by 9 times, and the incidence of HELLP syndrome and thrombosis will increase. Methods of treatment include termination of pregnancy, anticoagulation, corticosteroids, plasma exchange, and immunoglobulin.

Effect of APS on fetal stillbirth in 16.5%, intrauterine growth restriction 26.3%, 48.2% premature birth.

Drug treatment of SLE in pregnancy

Hydroxychloroquine and small dose (mg < 7.5) glucocorticoids can be used during pregnancy, it is recommended to avoid the use of immunosuppressive agents, if necessary, the provisional application of azathioprine. At least 1 calcium g/d prevention of preeclampsia. SLE activity can be a short time to increase the dosage of glucocorticoid or even intravenous injection, symptom control immediately reduce dosage, because glucocorticoid can increase the risk of premature rupture of membranes.

Drug treatment of APS in pregnancy

During pregnancy, the use of low molecular weight heparin began to take the anti platelet therapy. Warfarin should be discontinued after pregnancy, switch to low molecular weight heparin, because warfarin has teratogenic effect. For refractory APS can be combined with a small dose of glucocorticoid and hydroxychloroquine.

Lactation nurse used hydroxychloroquine, aspirin, heparin, Hua Falin has no effect on breast milk, suggest corticosteroids within 3 hours to stop breastfeeding.

 

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