Skip to main content
Erschienen in: Zeitschrift für Rheumatologie 1/2020

11.12.2019 | Frühgeburten | CME

Schwangerschaft bei rheumatischen Erkrankungen

verfasst von: PD Dr. med. R. Fischer-Betz, S. Späthling-Mestekemper

Erschienen in: Zeitschrift für Rheumatologie | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Zusammenfassung

Entzündlich-rheumatische Erkrankungen betreffen bevorzugt Frauen im gebärfähigen Alter. Immunologische Veränderungen können sich in positiver oder negativer Form auf die mütterliche Erkrankung auswirken. Die meisten Frauen können bei sorgfältiger medizinischer und geburtshilflicher Betreuung eine erfolgreiche Schwangerschaft haben. Dennoch sind Schwangerschaftskomplikationen weiterhin häufiger als bei gesunden Frauen. Schwangerschaften sollten daher in einer inaktiven Krankheitsphase und nach individueller Risikostratifizierung geplant werden. Insbesondere in Bezug auf eine kompatible Therapie ist eine eingehende Information der Patientinnen zur gemeinsamen Entscheidungsfindung notwendig.
Literatur
1.
Zurück zum Zitat Brouwer J, Fleurbaaij R, Hazes JMW et al (2017) Subfertility in women with rheumatoid arthritis and the outcome of fertility assessments. Arthritis Care Res 69(8):1142–1149CrossRef Brouwer J, Fleurbaaij R, Hazes JMW et al (2017) Subfertility in women with rheumatoid arthritis and the outcome of fertility assessments. Arthritis Care Res 69(8):1142–1149CrossRef
2.
Zurück zum Zitat Iwase A, Osuka S, Goto M et al (2018) Clinical application of serum anti-Müllerian hormone as an ovarian reserve marker: a review of recent studies. J Obstet Gynaecol Res 44(6):998–1006CrossRef Iwase A, Osuka S, Goto M et al (2018) Clinical application of serum anti-Müllerian hormone as an ovarian reserve marker: a review of recent studies. J Obstet Gynaecol Res 44(6):998–1006CrossRef
3.
Zurück zum Zitat Nørgård BM, Larsen MD, Friedman S et al (2019) Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study. Ann Rheum Dis 78(3):328–334CrossRef Nørgård BM, Larsen MD, Friedman S et al (2019) Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study. Ann Rheum Dis 78(3):328–334CrossRef
4.
Zurück zum Zitat Orquevaux P, Masseau A, Le Guern V et al (2015) In vitro fertilization and systemic lupus erythematosus or antiphospholipid syndrome: an update. Rev Med Interne 36(3):154–158CrossRef Orquevaux P, Masseau A, Le Guern V et al (2015) In vitro fertilization and systemic lupus erythematosus or antiphospholipid syndrome: an update. Rev Med Interne 36(3):154–158CrossRef
5.
Zurück zum Zitat Andreoli L, Bertsias GK, Agmon-Levin N et al (2017) EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 76(3):476–485CrossRef Andreoli L, Bertsias GK, Agmon-Levin N et al (2017) EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 76(3):476–485CrossRef
6.
Zurück zum Zitat Jethwa H, Lam S, Smith C, Giles I (2019) Does rheumatoid arthritis really improve during pregnancy? A systematic review and metaanalysis. J Rheumatol 46(3):245–250CrossRef Jethwa H, Lam S, Smith C, Giles I (2019) Does rheumatoid arthritis really improve during pregnancy? A systematic review and metaanalysis. J Rheumatol 46(3):245–250CrossRef
7.
Zurück zum Zitat Teng YKO, Bredewold EOW, Rabelink TJ et al (2018) An evidence-based approach to pre-pregnancy counselling for patients with systemic lupus erythematosus. Rheumatol (oxford) 57(10):1707–1720CrossRef Teng YKO, Bredewold EOW, Rabelink TJ et al (2018) An evidence-based approach to pre-pregnancy counselling for patients with systemic lupus erythematosus. Rheumatol (oxford) 57(10):1707–1720CrossRef
8.
Zurück zum Zitat Eudy AM, Siega-Riz AM, Engel SM et al (2018) Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Ann Rheum Dis 77(6):855–860PubMedPubMedCentral Eudy AM, Siega-Riz AM, Engel SM et al (2018) Effect of pregnancy on disease flares in patients with systemic lupus erythematosus. Ann Rheum Dis 77(6):855–860PubMedPubMedCentral
9.
Zurück zum Zitat Fischer-Betz R, Specker C (2017) Pregnancy in systemic lupus erythematosus and antiphos-pholipid syndrome. Best Pract Res Clin Rheumatol 31(3):397–414CrossRef Fischer-Betz R, Specker C (2017) Pregnancy in systemic lupus erythematosus and antiphos-pholipid syndrome. Best Pract Res Clin Rheumatol 31(3):397–414CrossRef
10.
Zurück zum Zitat Buyon JP, Kim MY, Guerra MM et al (2015) Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann Intern Med 163(3):153–163CrossRef Buyon JP, Kim MY, Guerra MM et al (2015) Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann Intern Med 163(3):153–163CrossRef
11.
Zurück zum Zitat Andreoli L, Gerardi M, Fernandes M et al (2018) Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies. Autoimmun Rev 2018(8):164–176 Andreoli L, Gerardi M, Fernandes M et al (2018) Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies. Autoimmun Rev 2018(8):164–176
14.
Zurück zum Zitat Bundhun PK, Soogund MZ, Huang F (2017) Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: a meta-analysis of studies published between years 2001–2016. J Autoimmun 2017(79):17–27CrossRef Bundhun PK, Soogund MZ, Huang F (2017) Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: a meta-analysis of studies published between years 2001–2016. J Autoimmun 2017(79):17–27CrossRef
15.
Zurück zum Zitat Götestam Skorpen C, Lydersen S, Gilboe IM et al (2018) Influence of disease activity and medications on offspring birth weight, pre-eclampsia and preterm birth in systemic lupus erythematosus: a population-based study. Ann Rheum Dis 77(2):264–269CrossRef Götestam Skorpen C, Lydersen S, Gilboe IM et al (2018) Influence of disease activity and medications on offspring birth weight, pre-eclampsia and preterm birth in systemic lupus erythematosus: a population-based study. Ann Rheum Dis 77(2):264–269CrossRef
16.
Zurück zum Zitat Clowse ME, Magder LS, Petri M (2011) The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythe-matosus. J Rheumatol 38(6):1012–1016CrossRef Clowse ME, Magder LS, Petri M (2011) The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythe-matosus. J Rheumatol 38(6):1012–1016CrossRef
17.
Zurück zum Zitat Wei S, Lai K, Yang Z, Zeng K (2017) Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies. Lupus 26(6):563–557CrossRef Wei S, Lai K, Yang Z, Zeng K (2017) Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies. Lupus 26(6):563–557CrossRef
18.
Zurück zum Zitat Normand G, Sens F, Puthet J et al (2019) Not only disease activity but also chronic hypertension and overweight are determinants of pregnancy outcomes in patients with systemic lupus erythematosus. Lupus 28(4):529–537CrossRef Normand G, Sens F, Puthet J et al (2019) Not only disease activity but also chronic hypertension and overweight are determinants of pregnancy outcomes in patients with systemic lupus erythematosus. Lupus 28(4):529–537CrossRef
19.
Zurück zum Zitat Chehab G, Richter JG, Brinks R et al (2018) Vaccination coverage in systemic lupus erythematosus—a cross-sectional analysis of the German long-term study (LuLa cohort). Rheumatology 57(8):1439–1447CrossRef Chehab G, Richter JG, Brinks R et al (2018) Vaccination coverage in systemic lupus erythematosus—a cross-sectional analysis of the German long-term study (LuLa cohort). Rheumatology 57(8):1439–1447CrossRef
20.
Zurück zum Zitat Leroux M, Desveaux C, Parcevaux M et al (2015) Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus 2015(24):1384–1391CrossRef Leroux M, Desveaux C, Parcevaux M et al (2015) Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study. Lupus 2015(24):1384–1391CrossRef
23.
Zurück zum Zitat Smith CJF, Bandoli G, Kavanaugh A, Chambers CD (2019) Birth outcomes and disease activity during pregnancy in a prospective cohort of women with psoriatic arthritis and ankylosing spondylitis. Arthritis Care Res. https://doi.org/10.1002/acr.23924 (Epub ahead of print)CrossRef Smith CJF, Bandoli G, Kavanaugh A, Chambers CD (2019) Birth outcomes and disease activity during pregnancy in a prospective cohort of women with psoriatic arthritis and ankylosing spondylitis. Arthritis Care Res. https://​doi.​org/​10.​1002/​acr.​23924 (Epub ahead of print)CrossRef
24.
Zurück zum Zitat Bröms G, Haerskjold A, Granath F et al (2018) Effect of maternal psoriasis on pregnancy and birth outcomes: a population-based cohort study from Denmark and Sweden. Acta Derm Venereol 98(8):728–734CrossRef Bröms G, Haerskjold A, Granath F et al (2018) Effect of maternal psoriasis on pregnancy and birth outcomes: a population-based cohort study from Denmark and Sweden. Acta Derm Venereol 98(8):728–734CrossRef
25.
Zurück zum Zitat Brito-Zerón P, Izmirly PM, Ramos-Casals M, Buyon JP, Khamashta MA (2015) The clinical spectrum of autoimmune congenital heart block. Nat Rev Rheumatol 11(5):301–312CrossRef Brito-Zerón P, Izmirly PM, Ramos-Casals M, Buyon JP, Khamashta MA (2015) The clinical spectrum of autoimmune congenital heart block. Nat Rev Rheumatol 11(5):301–312CrossRef
26.
Zurück zum Zitat Cuneo BF, Sonesson SE, Levasseur S et al (2018) Home monitoring for fetal heart rhythm during anti-Ro pregnancies. J Am Coll Cardiol 72(16):1940–1951 (Electronic)CrossRef Cuneo BF, Sonesson SE, Levasseur S et al (2018) Home monitoring for fetal heart rhythm during anti-Ro pregnancies. J Am Coll Cardiol 72(16):1940–1951 (Electronic)CrossRef
27.
Zurück zum Zitat Costedoat-Chalumeau N, Morel N, Fischer-Betz R et al (2019) Routine repeated echo-cardiographic monitoring of fetuses exposed to maternal anti-SSA antibodies: time to question this dogma. Lancet Rheumatol 1:e187–93 Costedoat-Chalumeau N, Morel N, Fischer-Betz R et al (2019) Routine repeated echo-cardiographic monitoring of fetuses exposed to maternal anti-SSA antibodies: time to question this dogma. Lancet Rheumatol 1:e187–93
28.
Zurück zum Zitat Izmirly PM, Costedoat-Chalumeau N, Pisoni CN et al (2012) Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 126(1):76–82CrossRef Izmirly PM, Costedoat-Chalumeau N, Pisoni CN et al (2012) Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 126(1):76–82CrossRef
29.
Zurück zum Zitat Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R et al (2019) The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): a survey of 1000 consecutive cases. Autoimmun Rev 18(4):406–414CrossRef Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R et al (2019) The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): a survey of 1000 consecutive cases. Autoimmun Rev 18(4):406–414CrossRef
31.
Zurück zum Zitat Götestam Skorpen C, Hoeltzenbein M, Tincani A et al (2016) The EULAR points to consider for use of anti rheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 75(5):795–810CrossRef Götestam Skorpen C, Hoeltzenbein M, Tincani A et al (2016) The EULAR points to consider for use of anti rheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 75(5):795–810CrossRef
32.
Zurück zum Zitat Flint J, Panchal S, Hurrell A et al (2016) BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology 55(9):1693–1697CrossRef Flint J, Panchal S, Hurrell A et al (2016) BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology 55(9):1693–1697CrossRef
33.
Zurück zum Zitat Komaki F, Komaki Y, Micic D et al (2017) Outcome of pregnancy and neonatal complications with anti-tumor necrosis factor‑α use in females with immune mediated diseases; a systematic review and meta-analysis. J Autoimmun 2017(76):38–52CrossRef Komaki F, Komaki Y, Micic D et al (2017) Outcome of pregnancy and neonatal complications with anti-tumor necrosis factor‑α use in females with immune mediated diseases; a systematic review and meta-analysis. J Autoimmun 2017(76):38–52CrossRef
34.
Zurück zum Zitat Förger F, Bandoli G, Luo Y et al (2019) No association of discontinuing tumor necrosis factor inhibitors before gestational week twenty in well-controlled rheumatoid arthritis and juvenile idiopathic arthritis with a disease worsening in late pregnancy. Arthritis Rheumatol 71(6):901–907CrossRef Förger F, Bandoli G, Luo Y et al (2019) No association of discontinuing tumor necrosis factor inhibitors before gestational week twenty in well-controlled rheumatoid arthritis and juvenile idiopathic arthritis with a disease worsening in late pregnancy. Arthritis Rheumatol 71(6):901–907CrossRef
35.
Zurück zum Zitat Vinet É, De Moura C, Pineau CA et al (2018) Serious infections in rheumatoid arthritis offspring exposed to tumor necrosis factor inhibitors: a cohort study. Arthritis Rheumatol 70(10):1565–1571CrossRef Vinet É, De Moura C, Pineau CA et al (2018) Serious infections in rheumatoid arthritis offspring exposed to tumor necrosis factor inhibitors: a cohort study. Arthritis Rheumatol 70(10):1565–1571CrossRef
36.
Zurück zum Zitat Cheent K, Nolan J, Shariq S, Kiho L, Pal A, Arnold J (2010) Case report: fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn’s disease. J Crohns Colitis 4(5):603–605CrossRef Cheent K, Nolan J, Shariq S, Kiho L, Pal A, Arnold J (2010) Case report: fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn’s disease. J Crohns Colitis 4(5):603–605CrossRef
37.
Zurück zum Zitat Mariette X, Förger F, Abraham B et al (2018) Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacoki-netic study. Ann Rheum Dis 77(2):228–233CrossRef Mariette X, Förger F, Abraham B et al (2018) Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacoki-netic study. Ann Rheum Dis 77(2):228–233CrossRef
38.
Zurück zum Zitat Mouyis M, Flint JD, Giles IP (2019) Safety of anti-rheumatic drugs in men trying to conceive: A systematic review and analysis of published evidence. Semin Arthritis Rheum 48(5):911–920CrossRef Mouyis M, Flint JD, Giles IP (2019) Safety of anti-rheumatic drugs in men trying to conceive: A systematic review and analysis of published evidence. Semin Arthritis Rheum 48(5):911–920CrossRef
Metadaten
Titel
Schwangerschaft bei rheumatischen Erkrankungen
verfasst von
PD Dr. med. R. Fischer-Betz
S. Späthling-Mestekemper
Publikationsdatum
11.12.2019
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Rheumatologie / Ausgabe 1/2020
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI
https://doi.org/10.1007/s00393-019-00736-8

Weitere Artikel der Ausgabe 1/2020

Zeitschrift für Rheumatologie 1/2020 Zur Ausgabe

Mitteilungen des BDRh

Mitteilungen des BDRh

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.