TY - JOUR
T1 - Pregnancy in autoimmune rheumatic diseases
T2 - The importance of counselling for old and new challenges
AU - Andreoli, Laura
AU - Bazzani, Chiara
AU - Taraborelli, Mara
AU - Reggia, Rossella
AU - Lojacono, Andrea
AU - Brucato, Antonio
AU - Meroni, Pier Luigi
AU - Tincani, Angela
PY - 2010/11
Y1 - 2010/11
N2 - Rheumatic diseases can affect women during their childbearing age. Therefore, physicians should introduce a discussion with the patients about pregnancy and its problems. Lupus pregnancies can be successful, even in patients with renal disease, when planned in remission state; the use of low dose aspirin was shown to be an independent predictor of good outcome, so it can be suggested as a preventive measure. Pregnancies in women with Antiphospholipid Syndrome can fail even if properly treated, especially when associated with a systemic autoimmune disease, a history of both thrombosis and pregnancy morbidity, and a triple positivity of antiphospholipid antibody assays. Women with systemic sclerosis have generally a good obstetric outcome, except for an increase rate of preterm deliveries. Severe disease complications were sometimes reported, but their relationship with gestation is not clear yet. Although data on human pregnancy are still preliminary, anti-TNF agents are classified as non teratogens in contrast to methotrexate and leflunomide. So women affected by aggressive chronic arthritis may be treated with anti-TNF in the pre-conceptional period, discontinuing the drug as soon as pregnancy starts. In order to increase maternal compliance and cope with difficult cases, a multidisciplinary team (rheumatologists/internists, obstetricians and neonatologists) should take care of patients during pregnancy.
AB - Rheumatic diseases can affect women during their childbearing age. Therefore, physicians should introduce a discussion with the patients about pregnancy and its problems. Lupus pregnancies can be successful, even in patients with renal disease, when planned in remission state; the use of low dose aspirin was shown to be an independent predictor of good outcome, so it can be suggested as a preventive measure. Pregnancies in women with Antiphospholipid Syndrome can fail even if properly treated, especially when associated with a systemic autoimmune disease, a history of both thrombosis and pregnancy morbidity, and a triple positivity of antiphospholipid antibody assays. Women with systemic sclerosis have generally a good obstetric outcome, except for an increase rate of preterm deliveries. Severe disease complications were sometimes reported, but their relationship with gestation is not clear yet. Although data on human pregnancy are still preliminary, anti-TNF agents are classified as non teratogens in contrast to methotrexate and leflunomide. So women affected by aggressive chronic arthritis may be treated with anti-TNF in the pre-conceptional period, discontinuing the drug as soon as pregnancy starts. In order to increase maternal compliance and cope with difficult cases, a multidisciplinary team (rheumatologists/internists, obstetricians and neonatologists) should take care of patients during pregnancy.
KW - Anti-TNF drugs
KW - Antiphospholipid Syndrome
KW - Lupus nephritis
KW - Pregnancy
KW - Rheumatic diseases
KW - Systemic sclerosis
UR - http://www.scopus.com/inward/record.url?scp=78149357080&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78149357080&partnerID=8YFLogxK
U2 - 10.1016/j.autrev.2010.08.004
DO - 10.1016/j.autrev.2010.08.004
M3 - Article
C2 - 20696283
AN - SCOPUS:78149357080
VL - 10
SP - 51
EP - 54
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
SN - 1568-9972
IS - 1
ER -