Skip to main content
Erschienen in: Zeitschrift für Rheumatologie 3/2006

01.05.2006 | Leitthema

Systemischer Lupus erythematodes und Antiphospholipidsyndrome in der Schwangerschaft

verfasst von: G. Ruiz-Irastorza, MD, FRCP, PhD M. A. Khamashta

Erschienen in: Zeitschrift für Rheumatologie | Ausgabe 3/2006

Einloggen, um Zugang zu erhalten

Zusammenfassung

Frauen mit systemischem Lupus erythematodes (SLE) und Antiphospholipidsyndrom (APS) können verschiedene Schwangerschaftskomplikationen erleiden, z. B. Reaktivierung des SLE, Thrombose, Fehlgeburt, Neugeborenenlupus, schwangerschaftsinduzierte Hypertonie, pulmonale Hypertonie und Arzneimitteltoxizität.
Das richtige Management dieser Patientinnen erfordert eine kombinierte geburtshilflich-medizinische Versorgung, die genaue Beobachtung des kindlichen Wachstums und Wohlergehens, eine Kontrolle der SLE-Aktivität und eine angemessene Thromboseprophylaxe. Bei guter Versorgung verlaufen die meisten Schwangerschaften von Frauen mit SLE und APS günstig.
Literatur
1.
Zurück zum Zitat Bates S, Greer IA, Hirsh J, Ginsberg JS (2004) Use of antithrombotic agents during pregnancy. The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126: 627S–644SCrossRefPubMed Bates S, Greer IA, Hirsh J, Ginsberg JS (2004) Use of antithrombotic agents during pregnancy. The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126: 627S–644SCrossRefPubMed
2.
Zurück zum Zitat Baud O, Foix-L’Helias L, Kamisnski M et al. (1999) Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants. N Engl J Med 341: 1190–1196CrossRefPubMed Baud O, Foix-L’Helias L, Kamisnski M et al. (1999) Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants. N Engl J Med 341: 1190–1196CrossRefPubMed
3.
Zurück zum Zitat Bonnin M, Mercier FJ, Sitbon O et al. (2005) Severe pulmonary hypertension during pregnancy. Mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiology 102: 1133–1137CrossRefPubMed Bonnin M, Mercier FJ, Sitbon O et al. (2005) Severe pulmonary hypertension during pregnancy. Mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiology 102: 1133–1137CrossRefPubMed
4.
Zurück zum Zitat Branch DW, Khamashta MA (2003) Antiphospholipid syndrome: obstetric diagnosis, management and controversies. Obstet Gynecol 101: 1333–1344CrossRefPubMed Branch DW, Khamashta MA (2003) Antiphospholipid syndrome: obstetric diagnosis, management and controversies. Obstet Gynecol 101: 1333–1344CrossRefPubMed
5.
Zurück zum Zitat Branch DW, Peaceman AM, Druzin M et al. (2000) A multicenter, placebo-controlled pilot study of intravenous immune globulin treatment of antiphospholipid syndrome during pregnancy. Am J Obstet Gynecol 182: 122–127CrossRefPubMed Branch DW, Peaceman AM, Druzin M et al. (2000) A multicenter, placebo-controlled pilot study of intravenous immune globulin treatment of antiphospholipid syndrome during pregnancy. Am J Obstet Gynecol 182: 122–127CrossRefPubMed
6.
Zurück zum Zitat Brucato A, Frassi M, Franceschini F et al. (2001) Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum 44: 1832–1835CrossRefPubMed Brucato A, Frassi M, Franceschini F et al. (2001) Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum 44: 1832–1835CrossRefPubMed
7.
Zurück zum Zitat Buyon JP, Kalunian KC, Ramsey-Goldman R et al. (1999) Assessing disease activity in SLE patients during pregnancy. Lupus 8: 677–684CrossRefPubMed Buyon JP, Kalunian KC, Ramsey-Goldman R et al. (1999) Assessing disease activity in SLE patients during pregnancy. Lupus 8: 677–684CrossRefPubMed
9.
Zurück zum Zitat Carmona F, Font J, Azulay M et al. (2001) Risk factors associated with fetal losses in treated antiphospholipid syndrome pregnancies: a multivariate analysis. Am J Reprod Immunol 46: 274–279CrossRefPubMed Carmona F, Font J, Azulay M et al. (2001) Risk factors associated with fetal losses in treated antiphospholipid syndrome pregnancies: a multivariate analysis. Am J Reprod Immunol 46: 274–279CrossRefPubMed
10.
Zurück zum Zitat Carmona F, Font J, Moga I et al. (2005) Class III-IV proliferative lupus nephritis and pregnancy: a study of 42 cases. Am J Reprod Immunol 53: 182–188CrossRefPubMed Carmona F, Font J, Moga I et al. (2005) Class III-IV proliferative lupus nephritis and pregnancy: a study of 42 cases. Am J Reprod Immunol 53: 182–188CrossRefPubMed
11.
Zurück zum Zitat Cervera R, Piette JC, Font J et al. (2002) Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 46: 1019–1027CrossRefPubMed Cervera R, Piette JC, Font J et al. (2002) Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 46: 1019–1027CrossRefPubMed
12.
Zurück zum Zitat Cowchock FS, Reece EA, Balaban D et al. (1992) Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin. Am J Obstet Gynecol 166: 1318–1323PubMed Cowchock FS, Reece EA, Balaban D et al. (1992) Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin. Am J Obstet Gynecol 166: 1318–1323PubMed
13.
Zurück zum Zitat Dekker GA, de Vries JI, Doelitzsch PM et al. (1995) Underlying disorders associated with severe early onset pre-eclampsia. Am J Obstet Gynecol 173: 1042–1048CrossRefPubMed Dekker GA, de Vries JI, Doelitzsch PM et al. (1995) Underlying disorders associated with severe early onset pre-eclampsia. Am J Obstet Gynecol 173: 1042–1048CrossRefPubMed
14.
Zurück zum Zitat Di Simone N, Meroni PL, de Papa N et al. (2000) Antiphospholipid antibodies affect trophoblast gonadotrophin secretion and invasiveness by binding directly and through adhred β2Glycoprotein I. Arthrits Rheum 43: 140–150CrossRef Di Simone N, Meroni PL, de Papa N et al. (2000) Antiphospholipid antibodies affect trophoblast gonadotrophin secretion and invasiveness by binding directly and through adhred β2Glycoprotein I. Arthrits Rheum 43: 140–150CrossRef
15.
Zurück zum Zitat Duckitt K, Harrington D (2005) Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. Br Med J 330: 565 Duckitt K, Harrington D (2005) Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. Br Med J 330: 565
16.
Zurück zum Zitat Duley L, Henderson-Smart D, Knight M, King J (2001) Antiplatelet drugs for prevention of pre-eclampsia and its consequences: systematic review. Br Med J 322: 329–333 Duley L, Henderson-Smart D, Knight M, King J (2001) Antiplatelet drugs for prevention of pre-eclampsia and its consequences: systematic review. Br Med J 322: 329–333
17.
Zurück zum Zitat Erkan D, Merririll JT, Yazici Y et al. (2001) High thrombosis rate after fetal loss in antiphospholipid syndrome: effective prophylaxis with aspirin. Arthritis Rheum 44: 1466–1467CrossRefPubMed Erkan D, Merririll JT, Yazici Y et al. (2001) High thrombosis rate after fetal loss in antiphospholipid syndrome: effective prophylaxis with aspirin. Arthritis Rheum 44: 1466–1467CrossRefPubMed
18.
Zurück zum Zitat Farquharson RG, Quenby S, Greaves M (2002) Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecol 100: 408–413CrossRefPubMed Farquharson RG, Quenby S, Greaves M (2002) Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecol 100: 408–413CrossRefPubMed
19.
Zurück zum Zitat Galie N, Manes A, Farahani KV et al. (2005) Pulmonary arterial hypertension associated to connective tissue diseases. Lupus 14: 713–717CrossRefPubMed Galie N, Manes A, Farahani KV et al. (2005) Pulmonary arterial hypertension associated to connective tissue diseases. Lupus 14: 713–717CrossRefPubMed
20.
Zurück zum Zitat Girardi G, Redecha P, Salmon JE (2004) Heparin prevents antiphospholid antibody-induced fetal loss by inhibiting complement activation. Nature Med 10: 1222–1226CrossRefPubMed Girardi G, Redecha P, Salmon JE (2004) Heparin prevents antiphospholid antibody-induced fetal loss by inhibiting complement activation. Nature Med 10: 1222–1226CrossRefPubMed
22.
Zurück zum Zitat Khamashta MA, Ruiz-Irastorza G, Hughes GRV (1997) Systemic lupus erythematosus flares during pregnancy. Rheum Dis Clin North Am 23: 15–30CrossRefPubMed Khamashta MA, Ruiz-Irastorza G, Hughes GRV (1997) Systemic lupus erythematosus flares during pregnancy. Rheum Dis Clin North Am 23: 15–30CrossRefPubMed
23.
Zurück zum Zitat Le Thi Huong D, Wechsler B, Vauthier-Brouzes D et al. (1997) Outcome of planned pregnancies in systemic lupus erythematosus: a prospective study on 62 pregnancies. Br J Rheumatol 36: 772–777CrossRefPubMed Le Thi Huong D, Wechsler B, Vauthier-Brouzes D et al. (1997) Outcome of planned pregnancies in systemic lupus erythematosus: a prospective study on 62 pregnancies. Br J Rheumatol 36: 772–777CrossRefPubMed
24.
Zurück zum Zitat Lima F, Khamashta MA, Buchanan NMM et al. (1996) A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol 14: 131–136PubMed Lima F, Khamashta MA, Buchanan NMM et al. (1996) A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol 14: 131–136PubMed
25.
Zurück zum Zitat Lockshin MD, Drunzin Ml, Qamar T (1989) Prednisone does not prevent recurrent fetal death in women with antiphospholipid antibody. Am J Obstet Gynecol 160: 439–443PubMed Lockshin MD, Drunzin Ml, Qamar T (1989) Prednisone does not prevent recurrent fetal death in women with antiphospholipid antibody. Am J Obstet Gynecol 160: 439–443PubMed
26.
Zurück zum Zitat Lynch A, Silver R, Emlen W, Branch DW (1997) Antiphospholipid antibodies in healthy pregnant women. Rheum Dis Clin North Am 23: 55–70CrossRefPubMed Lynch A, Silver R, Emlen W, Branch DW (1997) Antiphospholipid antibodies in healthy pregnant women. Rheum Dis Clin North Am 23: 55–70CrossRefPubMed
27.
Zurück zum Zitat McMillan E, Martin WL, Waugh J et al. (2002) Management of pregnancy in women with pulmonary hypertension secondary to SLE and anti-phospholipid syndrome. Lupus 11: 392–328CrossRefPubMed McMillan E, Martin WL, Waugh J et al. (2002) Management of pregnancy in women with pulmonary hypertension secondary to SLE and anti-phospholipid syndrome. Lupus 11: 392–328CrossRefPubMed
28.
Zurück zum Zitat Milne F, Redman C, Walker J et al. (2005) The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. Br Med J 330: 576–580 Milne F, Redman C, Walker J et al. (2005) The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. Br Med J 330: 576–580
29.
Zurück zum Zitat Nelson-Piercy C (1997) Hypertension and pre-eclampsia. In: Nelson-Piercy C (ed) Handbook of obstetric medicine. Isis medical media, Oxford, pp 1–16 Nelson-Piercy C (1997) Hypertension and pre-eclampsia. In: Nelson-Piercy C (ed) Handbook of obstetric medicine. Isis medical media, Oxford, pp 1–16
30.
Zurück zum Zitat Papageorghiou AT, Roberts N (2005) Uterine artery Doppler screening for adverse pregnancy outcome. Curr Opin Obstet Gynecol 17: 584–590PubMed Papageorghiou AT, Roberts N (2005) Uterine artery Doppler screening for adverse pregnancy outcome. Curr Opin Obstet Gynecol 17: 584–590PubMed
31.
Zurück zum Zitat Pierangeli SS, Girardi G, Vega-Ostertag M et al. (2005) Requirement of activation of complement C3 and C5 for antiphospholipid antibody-mediated thrombophilia. Arthritis Rheum 52: 2120–2124CrossRefPubMed Pierangeli SS, Girardi G, Vega-Ostertag M et al. (2005) Requirement of activation of complement C3 and C5 for antiphospholipid antibody-mediated thrombophilia. Arthritis Rheum 52: 2120–2124CrossRefPubMed
32.
Zurück zum Zitat Rai R, Cohen H, Dave M, Regan L (1997) Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). Br Med J 314: 253–257 Rai R, Cohen H, Dave M, Regan L (1997) Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). Br Med J 314: 253–257
33.
Zurück zum Zitat Ruiz-Irastorza G, Khamashta MA (2004) Evaluation of systemic lupus erythematosus activity during pregnancy. Lupus 13: 679–682CrossRefPubMed Ruiz-Irastorza G, Khamashta MA (2004) Evaluation of systemic lupus erythematosus activity during pregnancy. Lupus 13: 679–682CrossRefPubMed
34.
Zurück zum Zitat Ruiz-Irastorza G, Khamashta MA (2005) Management of thrombosis in antiphospholipid syndrome and systemic lupus erythematosus in pregnancy. Ann N Y Acad Sci 1051: 606–612CrossRefPubMed Ruiz-Irastorza G, Khamashta MA (2005) Management of thrombosis in antiphospholipid syndrome and systemic lupus erythematosus in pregnancy. Ann N Y Acad Sci 1051: 606–612CrossRefPubMed
35.
Zurück zum Zitat Ruiz-Irastorza G, Lima F, Alves J et al. (1996) Increased rate of lupus flare during pregnancy and the puerperium: a prospective study of 78 pregnancies. Br J Rheumatol 35: 133–138PubMed Ruiz-Irastorza G, Lima F, Alves J et al. (1996) Increased rate of lupus flare during pregnancy and the puerperium: a prospective study of 78 pregnancies. Br J Rheumatol 35: 133–138PubMed
36.
Zurück zum Zitat Ruiz-Irastorza G, Khamashta MA, Nelson-Piercy C, Hughes GRV (2001) Lupus pregnancy: is heparin a risk factor for osteoporosis? Lupus 10: 597–600CrossRefPubMed Ruiz-Irastorza G, Khamashta MA, Nelson-Piercy C, Hughes GRV (2001) Lupus pregnancy: is heparin a risk factor for osteoporosis? Lupus 10: 597–600CrossRefPubMed
37.
Zurück zum Zitat Ruiz-Irastorza G, Khamashta MA, Hughes GRV (2002 a) Treatment of pregnancy loss in Hughes syndrome: a critical update. Autoimmun Rev 1: 298–304CrossRefPubMed Ruiz-Irastorza G, Khamashta MA, Hughes GRV (2002 a) Treatment of pregnancy loss in Hughes syndrome: a critical update. Autoimmun Rev 1: 298–304CrossRefPubMed
38.
Zurück zum Zitat Ruiz-Irastorza G, Khamashta MA, Nelson-Piercy C, Hughes GRV (2002 b) Effects of lupus and antiphospholipid syndrome on pregnancy. Yearbook of Obstet Gynecol 10: 105–119 Ruiz-Irastorza G, Khamashta MA, Nelson-Piercy C, Hughes GRV (2002 b) Effects of lupus and antiphospholipid syndrome on pregnancy. Yearbook of Obstet Gynecol 10: 105–119
39.
Zurück zum Zitat Ruiz-Irastorza G, Khamashta MA, Gordon C et al. (2004) Measuring systemic lupus erythematosus activity during pregnancy: validation of the Lupus Activity Index in Pregnancy scale. Arthritis Rheum (Arthritis Care & Research) 51: 78–82 Ruiz-Irastorza G, Khamashta MA, Gordon C et al. (2004) Measuring systemic lupus erythematosus activity during pregnancy: validation of the Lupus Activity Index in Pregnancy scale. Arthritis Rheum (Arthritis Care & Research) 51: 78–82
40.
Zurück zum Zitat Saaleb S, Copel J, Friedman D, Buyon JP (1999) Comparison of treatment with fluorinated glucocorticoids to the natural history of autoantibody-associated congenital heart block. Arthritis Rheum 42: 2335–2345CrossRefPubMed Saaleb S, Copel J, Friedman D, Buyon JP (1999) Comparison of treatment with fluorinated glucocorticoids to the natural history of autoantibody-associated congenital heart block. Arthritis Rheum 42: 2335–2345CrossRefPubMed
41.
Zurück zum Zitat Silver RK, MacGregor SN, Sholl JS et al. (1993) Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody-positive obstetric patients. Am J Obstet Gynecol 169: 1411–1417PubMed Silver RK, MacGregor SN, Sholl JS et al. (1993) Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody-positive obstetric patients. Am J Obstet Gynecol 169: 1411–1417PubMed
42.
Zurück zum Zitat Silver RM, Porter TF, van Leeuween I et al. (1996) Anticardiolipin antibodies: clinical consequences of „low titers“. Obstet Gynecol 87: 494–500CrossRefPubMed Silver RM, Porter TF, van Leeuween I et al. (1996) Anticardiolipin antibodies: clinical consequences of „low titers“. Obstet Gynecol 87: 494–500CrossRefPubMed
43.
Zurück zum Zitat Stone S, Khamashta MA, Poston L (2001) Placentation, antiphospholipid syndrome and pregnancy outcome. Lupus 10: 67–74CrossRefPubMed Stone S, Khamashta MA, Poston L (2001) Placentation, antiphospholipid syndrome and pregnancy outcome. Lupus 10: 67–74CrossRefPubMed
44.
Zurück zum Zitat Tincani A, Branch W, Levy RA et al. (2003) Treatment of pregnant patients with antiphospholipid syndrome. Lupus 12: 524–529CrossRefPubMed Tincani A, Branch W, Levy RA et al. (2003) Treatment of pregnant patients with antiphospholipid syndrome. Lupus 12: 524–529CrossRefPubMed
45.
Zurück zum Zitat Triolo G, Ferrante A, Ciccia F et al. (2003) Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies. Arthritis Rheum 48: 728–731CrossRefPubMed Triolo G, Ferrante A, Ciccia F et al. (2003) Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies. Arthritis Rheum 48: 728–731CrossRefPubMed
Metadaten
Titel
Systemischer Lupus erythematodes und Antiphospholipidsyndrome in der Schwangerschaft
verfasst von
G. Ruiz-Irastorza
MD, FRCP, PhD M. A. Khamashta
Publikationsdatum
01.05.2006
Verlag
Steinkopff-Verlag
Erschienen in
Zeitschrift für Rheumatologie / Ausgabe 3/2006
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI
https://doi.org/10.1007/s00393-006-0058-z

Weitere Artikel der Ausgabe 3/2006

Zeitschrift für Rheumatologie 3/2006 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Reizdarmsyndrom: Diäten wirksamer als Medikamente

29.04.2024 Reizdarmsyndrom Nachrichten

Bei Reizdarmsyndrom scheinen Diäten, wie etwa die FODMAP-arme oder die kohlenhydratreduzierte Ernährung, effektiver als eine medikamentöse Therapie zu sein. Das hat eine Studie aus Schweden ergeben, die die drei Therapieoptionen im direkten Vergleich analysierte.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Update Innere Medizin

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