Zusammenfassung
Entzündlich rheumatische Erkrankungen betreffen häufig Frauen im gebärfähigen Alter, für die eine Schwangerschaft nach wie vor mit erhöhten Risiken einhergeht. Gleichzeitig gewinnen wir immer mehr Einblick in Risikofaktoren und Präventionsmöglichkeiten, sodass für die meisten Frauen erfolgreiche und komplikationsarme Schwangerschaften möglich sind. Grundpfeiler sind eine Planung der Schwangerschaft unter guter Krankheitskontrolle und die Modifikation von behandelbaren Risikofaktoren. Dabei rückt erneut Hydroxychloroquin als Substanz mit vielfältigen positiven Wirkungen in den Fokus. Vom American College of Rheumatology (ACR) publizierte Empfehlungen geben einen praxisnahen Überblick zur Evidenzlage. Rheumatologen können, basierend auf dem aktuellen Wissensstand, nachhaltig zu einem positiven Schwangerschaftsverlauf für Mutter und Kind beitragen.
Abstract
Inflammatory rheumatic diseases often affect women of childbearing age, for whom pregnancy is still associated with increased risks. At the same time, we are gaining more and more insights into risk factors and preventive strategies, enabling almost all women to have successful pregnancies with few adverse outcomes. The cornerstones are planning of the pregnancy under effective disease control and the modification of individual risk factors. Hydroxychloroquine is once again coming into focus as a compound with multiple positive effects. Recommendations published by the American College of Rheumatology (ACR) provide a practical overview of the evidence. Based on the current state of knowledge, rheumatologists can make a lasting contribution to a positive pregnancy outcome for mother and child.
Literatur
(2020) Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstetrics and gynecology 135(6):e237–e260. https://doi.org/10.1097/AOG.0000000000003891
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):406–414. https://doi.org/10.1016/j.autrev.2018.12.006
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):476–485. https://doi.org/10.1136/annrheumdis-2016-209770
Brito-Zerón P, Izmirly PM, Ramos-Casals M et al (2015) The clinical spectrum of autoimmune congenital heart block. Nat Rev Rheumatol 11(5):301–312. https://doi.org/10.1038/nrrheum.2015.29
Brouwer J, Hazes JMW, Laven JSE et al (2015) Fertility in women with rheumatoid arthritis. Influence of disease activity and medication. Ann Rheum Dis 74(10):1836–1841. https://doi.org/10.1136/annrheumdis-2014-205383
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):153–163. https://doi.org/10.7326/M14-2235
Clowse MEB, Chakravarty E, Costenbader KH et al (2012) Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 64(5):668–674. https://doi.org/10.1002/acr.21593
Costedoat-Chalumeau N, Morel N, Fischer-Betz R et al (2019) Routine repeated echocardiographic monitoring of fetuses exposed to maternal anti-SSA antibodies: time to question the dogma. Lancet Rheumatol 1(3):e187–e193. https://doi.org/10.1016/S2665-9913(19)30069-4
https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic. Zugegriffen: 9. Mai 2021
Friedman DM, Kim M, Costedoat-Chalumeau N et al (2020) Electrocardiographic QT intervals in infants exposed to hydroxychloroquine throughout gestation. Circ Arrhythm Electrophysiol 13(10):e8686. https://doi.org/10.1161/CIRCEP.120.008686
Götestam Skorpen C, Lydersen S, Gilboe I‑M et al (2018) Women with systemic lupus erythematosus get pregnant more easily than women with rheumatoid arthritis. Rheumatology. https://doi.org/10.1093/rheumatology/key049
Jethwa H, Lam S, Smith C et al (2019) Does rheumatoid arthritis really improve during pregnancy? A systematic review and metaanalysis. J Rheumatol 46(3):245–250. https://doi.org/10.3899/jrheum.180226
He WR, Wei H (2020) Maternal and fetal complications associated with systemic lupus erythematosus: an updated meta-analysis of the most recent studies (2017–2019). Medicine 99(16):e19797. https://doi.org/10.1097/MD.0000000000019797
Ince-Askan H, Hazes JMW, Dolhain RJEM (2017) Identifying clinical factors associated with low disease activity and remission of rheumatoid arthritis during pregnancy. Arthritis Care Res 69(9):1297–1303. https://doi.org/10.1002/acr.23143
Izmirly P, Kim M, Friedman DM et al (2020) Hydroxychloroquine to prevent recurrent congenital heart block in fetuses of anti-SSA/Ro-positive mothers. J Am Coll Cardiol 76(3):292–302. https://doi.org/10.1016/j.jacc.2020.05.045
Jakobsson GL, Stephansson O, Askling J et al (2016) Pregnancy outcomes in patients with ankylosing spondylitis. A nationwide register study. Ann Rheum Dis 75(10):1838–1842. https://doi.org/10.1136/annrheumdis-2015-207992
Keeling SO, Bowker SL, Savu A et al (2020) A population-level analysis of the differing effects of rheumatoid arthritis and spondyloarthritis on peripartum outcomes. J Rheumatol 47(2):197–203. https://doi.org/10.3899/jrheum.181320
Mehta B, Luo Y, Xu J et al (2019) Trends in maternal and fetal outcomes among pregnant women with systemic lupus erythematosus in the United States: a cross-sectional analysis. Ann Intern Med 171(3):164–171. https://doi.org/10.7326/M19-0120
Nathan NO, Mørch LS, Wu CS et al (2020) Rheumatoid arthritis and risk of spontaneous abortion: a Danish nationwide cohort study. Rheumatology 59(8):1984–1991. https://doi.org/10.1093/rheumatology/kez565
Rolnik DL, O’Gorman N, Roberge S et al (2017) Early screening and prevention of preterm pre-eclampsia with aspirin: time for clinical implementation. Ultrasound Obstet Gynecol 50(5):551–556. https://doi.org/10.1002/uog.18899
Saavedra MÁ, Miranda-Hernández D, Lara-Mejía A et al (2020) Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: a prospective cohort study. Int J Rheum Dis 23(5):633–640. https://doi.org/10.1111/1756-185X.13830
Sammaritano LR, Bermas BL, Chakravarty EE et al (2020) 2020 American college of rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol 72(4):529–556. https://doi.org/10.1002/art.41191
Simard JF, Rossides M, Arkema EV et al (2021) Maternal hypertensive disorders in pregnant women with systemic lupus erythematosus and future cardiovascular outcomes. Arthritis Care Res 73(4):574–579. https://doi.org/10.1002/acr.24160
Smyth A, Oliveira GHM, Lahr BD et al (2010) A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 5(11):2060–2068. https://doi.org/10.2215/CJN.00240110
Tani C, Zucchi D, Haase I et al (2021) Are remission and low disease activity state ideal targets for pregnancy planning in Systemic Lupus Erythematosus? A multicentre study. Rheumatology. https://doi.org/10.1093/rheumatology/keab155
Tektonidou MG, Andreoli L, Limper M et al (2019) EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 78(10):1296–1304. https://doi.org/10.1136/annrheumdis-2019-215213
Ursin K, Lydersen S, Skomsvoll JF et al (2018) Disease activity during and after pregnancy in women with axial spondyloarthritis. A prospective multicentre study. Rheumatology. https://doi.org/10.1093/rheumatology/key047
Ursin K, Lydersen S, Skomsvoll JF et al (2020) Factors associated with time to pregnancy in women with axial spondyloarthritis: a registry-based multicenter study. Arthritis Care Res. https://doi.org/10.1002/acr.24233
van den Brandt S, Zbinden A, Baeten D et al (2017) Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther 19(1):64. https://doi.org/10.1186/s13075-017-1269-1
Zbinden A, van den Brandt S, Østensen M et al (2018) Risk for adverse pregnancy outcome in axial spondyloarthritis and rheumatoid arthritis: disease activity matters. Baillieres Clin Rheumatol 59:1241. https://doi.org/10.1093/rheumatology/key053
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Rebecca Fischer-Betz, Düsseldorf
Frauke Förger, Bern
Anja Strangfeld, Berlin
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Haase, I., Fischer-Betz, R. State of the Art: Fertilität und Schwangerschaft bei rheumatischen Erkrankungen. Z Rheumatol 80, 699–706 (2021). https://doi.org/10.1007/s00393-021-01073-5
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DOI: https://doi.org/10.1007/s00393-021-01073-5
Schlüsselwörter
- Rheumatoide Arthritis
- Systemischer Lupus erythematodes
- Spondyloarthritis
- Schwangerschaftskomplikationen
- Schwangerschaftsplanung