Información del artículo
Resumen
El lupus eritematoso sistémico (LES) se asocia con diversos eventos adversos en el embarazo como parto prematuro, pre-eclampsia y pérdidas gestacionales. Gracias a los avances terapéuticos el pronóstico del embarazo en mujeres con LES ha mejorado. Además de las complicaciones relacionadas con el embarazo, las mujeres con LES tienen un alto riesgo de complicaciones médicas durante la gestación como hipertensión, enfermedad renal, síndrome antifosfolípido, diabetes pregestacional o actividad lúpica, las cuales afectan el curso de la enfermedad y empeoran los resultados del embarazo. El embarazo aumenta la probabilidad de recaídas del LES. Aunque no es posible predecir cuándo se presentará una recaída en una paciente, esta es más probable si la enfermedad ha permanecido activa en los seis meses previos a la concepción.
Palabras clave:
lupus eritematoso sistémico
embarazo
resultados obstétricos
Summary
Systemic lupus erythematosus (SLE) is associated with multiple adverse pregnancy outcomes, including fetal loss, preterm birth, and pre-eclampsia. With treatment advances, the prognosis of pregnancy in women with SLE has improved. In addition to complications related to pregnancy, SLE women are at increased risk for medical complications during pregnancy such as hypertension, renal disease, antiphospholipid syndrome, pregestational diabetes or active SLE which affect the course of the disease and worse the outcome of pregnancy. Pregnancy increases the likelihood of a lupus flare. It is not possible to predict when an individual patient will flare, although flare is more likely if disease has been active within six months of conception.
Key words:
systemic lupus erythematosus
pregnancy
obstetric outcome
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Referencias
[1.]
C.A. Clark, K.A. Spitzer, C.A. Laskin.
Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40-year period.
J Rheumatol, 32 (2005), pp. 1709-1712
[2.]
D. Erkan, L. Sammaritano.
New insights into pregnancyrelated complications in systemic lupus erythematosus.
Curr Rheumatol Rep, 5 (2003), pp. 357-363
[4.]
M.R. Toglia, J.C. Wege.
Venous thromboembolism during pregnancy.
N Engl J Med, 335 (1996), pp. 107-114
[5.]
National Institutes of Health Consensus Development Conference. Prevention of venous thrombosis and pulmonary embolism.
JAMA, 256 (1986), pp. 744-749
[6.]
R.F. Burrows, J.G. Kelton.
Incidentally detected thrombocytopenia in healthy mothers and their infants.
N Engl J Med, 319 (1988), pp. 142-145
[7.]
J.R. Head, R.E. Billingham.
Concerning the immunology of the uterus.
Am J Reprod Immunol Microbiol, 10 (1986), pp. 76-81
[8.]
O. Thellin, B. Coumans, W. Zorzi, A. Igout, E. Heinen.
Tolerance to the foeto-placental ‘graft’: ten ways to support a child for nine months.
Curr Opin Immunol, 12 (2000), pp. 731-737
[9.]
C. Ober, H.L.A. Pregnancy.
The Paradox of the Fetal Allograft.
Am J Hum Genet, 62 (1998), pp. 1-5
[10.]
G.A. Karpouzas, R.C. Kitridou.
The mother in systemic lupus erythematosus.
Dubois'Lupus Erythematosus, 7th, pp. 992-1038
[11.]
N. Gleicher.
Autoantibodies in normal and abnormal pregnancy.
Am J Reprod Immunol, 28 (1992), pp. 269-273
[12.]
G. Ruiz-Irastorza, M.A. Khamashta.
Managing lupus patients during pregnancy.
Best Pract Res Clin Rheumatol, 23 (2009), pp. 575-582
[13.]
M.A. Khamashta.
Systemic lupus erythematosus pregnancy.
Best Pract Res Clin Rheumatol, 20 (2006), pp. 685-694
[14.]
R.M. Andrade, G. McGwin Jr., G.S. Alarcón, M.L. Sánchez, A.M. Bertoli, M. Fernández, et al.
Predictors of postpartum damage accrual in systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (XXXVIII).
Rheumatology, 45 (2006), pp. 1380-1384
[16.]
N. Costedoat-Chalumeau, Z. Amoura, P. Duhaut, D.L. Huong, D. Sebbough, B. Wechsler, et al.
Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: a study of one hundred thirty-three cases compared with a control group.
Arthritis Rheum, 48 (2003), pp. 3207-3211
[17.]
M.E. Clowse, L. Magder, F. Witter, M. Petri.
Hydroxychloroquine in lupus pregnancy.
Arthritis Rheum, 54 (2006), pp. 3640-3647
[18.]
G. Ruiz-Irastorza, M.A. Khamashta.
Lupus and pregnancy: integrating clues from the bench and bedside.
Eur J Clin Invest, 41 (2010), pp. 672-678
[19.]
F. Lima, M.A. Khamashta, N.M. Buchanan, S. Kerslake, B.J. Hunt, G.R. Hughes.
A study of sixty pregnancies in patients with the antiphospholipid syndrome.
Clin Exp Rheumatol, 14 (1996), pp. 131-136
[20.]
D.W. Branch, M.A. Khamashta.
Antiphospholipid syndrome: obstetric diagnosis, management and controversies.
Obstet Gynecol, 101 (2003), pp. 1333-1344
[21.]
P.M. Izmirly, T.L. Rivera, J.P. Buyon.
Neonatal lupus syndromes.
Rheum Dis Clin North Am, 33 (2007), pp. 267-285
[22.]
G. Moroni, S. Quaglini, G. Banfi, M. Caloni, S. Finazzi, et al.
Pregnancy in lupus nephritis.
Am J Kidney Dis, 40 (2002), pp. 713-720
[23.]
M. Bonnin, F.J. Mercier, O. Sitbon, S. Roger-Christoph, X. Jaïs, M. Humbert, et al.
Severe pulmonary hypertension during pregnancy Mode of delivery and anesthetic management of 15 consecutive cases.
Anesthesiology, 102 (2005), pp. 1133-1137
[24.]
J.P. Buyon, K.C. Kalunian, R. Ramsey-Goldman, M.A. Petri, M.D. Lockshin, G. Ruiz-Irastorza, et al.
Assessing disease activity in SLE patients during pregnancy.
Lupus, 8 (1999), pp. 677-684
[25.]
D. Le Thi Huong, B. Wechsler, D. Vauthier-Brouzes, P. Duhaut, N. Costedoat, M.R. Andreu, et al.
The second trimester Doppler ultrasound examination is the best predictor of late pregnancy outcome in systemic lupus erythematosus and/or the antiphospholipid syndrome.
Rheumatology, 45 (2006), pp. 332-338
[26.]
M.E. Clowse.
Lupus activity in pregnancy.
Rheum Dis Clin N Am, 33 (2007), pp. 237-252
[27.]
M.E. Clowse, L.S. Magder, F. Witter, M. Petri.
The impact of increased lupus activity on obstetric outcomes.
Arthritis Rheum, 52 (2005), pp. 514-521
[28.]
E.F. Chakravarty, I. Colón, E.S. Langen, D.A. Nix, Y.Y.A. El-Sayed, M.C. Genovese, et al.
Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus.
Am J Obstet Gynecol, 192 (2005), pp. 1897-1904
[29.]
M.B. Urowitz, D.D. Gladman, V.T. Farewell, J. Stewart, J. McDonald.
Lupus and pregnancy studies.
Arthritis Rheum, 36 (1993), pp. 1392-1397
[30.]
C.A. Clark, K.A. Spitzer, J.N. Nadler, C.A. Laskin.
Preterm deliveries in women with systemic lupus erythematosus.
J Rheumatol, 30 (2003), pp. 2127-2132
[31.]
M.E. Clowse, L.S. Magder, F. Witter, M. Petri.
Early risk factors for pregnancy loss in lupus.
Obstet Gynecol, 107 (2006), pp. 293-299
[32.]
M.S. Magid, C. Kaplan, L.R. Sammaritano, M. Peterson, M.L. Druzin, M.D. Lockshin.
Placental pathology in systemic lupus erythematosus: a prospective study.
Am J Obstet Gynecol, 179 (1998), pp. 226-234
[33.]
M.E. Clowse, M. Jamison, E. Myers, A.H. James.
A national study of the complications of lupus in pregnancy.
Am J Obstet Gynecol, 199 (2008), pp. e1-e6
[34.]
R. Andrade, M.L. Sanchez, G.S. Alarcón, B.J. Fessler, M. Fernández, A.M. Bertoli, et al.
Adverse pregnancy outcomes in women with systemic lupus erythematosus from a multiethnic US cohort: LUMINA (LVI).
Clin Exp Rheumatol, 26 (2008), pp. 268-274
[35.]
G. Moroni, C. Ponticelli.
The risk of pregnancy in patients with lupus nephritis.
J Nephrol, 16 (2003), pp. 161-167
[36.]
F. Lima, N.M. Buchanan, M.A. Khamashta, S. Kerslake, G.R. Hughes.
Obstetric outcome in systemic lupus erythematosus.
Semin Arthritis Rheum, 25 (1995), pp. 184-192
[37.]
H.C. Nossent, T.J. Swaak.
Systemic lupus erythematosus VI. Analysis of the interrelationship with pregnancy.
J Rheumatol, 17 (1990), pp. 771-776
[38.]
G.A. Karpouzas, R.C. Kitridou.
The mother in systemic lupus erythematosus.
Dubois' Lupus Erythematosus, 7th, pp. 992-1038
[39.]
M. Vainio, A. Riutta, A.M. Koivisto, J. Mäenpää.
Prostacyclin, thromboxane A and the effect of low-dose ASA in pregnancies at high risk for hypertensive disorders.
Acta Obstet Gynecol Scand, 83 (2004), pp. 1119-1123
[40.]
L.M. Askie, L. Duley, D.J. Henderson-Smart, L.A. Stewart, PARIS Collaborative Group.
Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data.
Lancet, 369 (2007), pp. 1791-1798
[41.]
L. Duley, D.J. Henderson-Smart, S. Meher, J.F. King.
Antiplatelet agents for preventing pre-eclampsia and its complications.
Cochrane Database Syst Rev, 2 (2007), pp. CD004659
[42.]
M.E. Clowse.
Managing contraception and pregnancy in the rheumatologic diseases.
Best Pract Res Clin Rheumatol, 24 (2010), pp. 373-385
[43.]
C. Bombardier, D.D. Gladman, M.B. Urowitz, D. Caron, C.H. Chang.
Derivation of the SLEDAI. A disease activity index for lupus patients The Committee on Prognosis Studies in SLE.
Arthritis Rheum, 35 (1992), pp. 630-640
[44.]
M.A. Khamashta, G. Ruiz-Irastorza, G.R. Hughes.
Systemic lupus erythematosus flares during pregnancy.
Rheum Dis Clin N Am, 23 (1997), pp. 15-30
[45.]
K. Higby, C.R. Suiter, J.Y. Phelps, T. Siler-Khodr, O. Langer.
Normal values of urinary albumin and total protein excretion during pregnancy.
Am J Obstet Gynecol, 171 (1994), pp. 984-989
[46.]
J.P. Buyon, J. Tamerius, S. Ordorica, B. Young, S.B. Abramson.
Activation of the alternative complement pathway accompanies disease flares in systemic lupus erythematosus during pregnancy.
Arthritis Rheum, 35 (1992), pp. 55-61
[47.]
M.E.B. Clowse, L.S. Magder, M. Petri.
Complement and double-stranded DNAantibodies predict pregnancy outcomes in lupus patients.
Arthritis Rheum, 50 (2004), pp. S408
[48.]
M.E. Clowse, L.S. Magder, M. Petri.
The Clinical Utility of Measuring Complement and Anti-dsDNA Antibodies during Pregnancy in Patients with Systemic Lupus Erythematosus.
J Rheumatol, (2011),
[49.]
M. Petri.
The Hopkins Lupus Pregnancy Center: ten key issues in management.
Rheum Dis Clin North Am, 33 (2007), pp. 227-235
[50.]
D.K. Li, L. Liu, R. Odouli.
Exposure to non-steroidal antiinflammatory drugs during pregnancy and risk of miscarriage: population based cohort study.
BMJ, 327 (2003), pp. 368-372
[51.]
S. Topuz, R. Has, H. Ermis, A. Yildirim, L. Ibrahimoglu, A. Yüksel.
Acute severe reversible oligohydramnios induced by indomethacin in a patient with rheumatoid arthritis: a case report and review of the literature.
Clin Exp Obstet Gynecol, 31 (2004), pp. 70-72
[52.]
M. Østensen, M. Khamashta, M. Lockshin, A. Parke, A. Brucato, H. Carp, et al.
Anti-inflammatory and immunosuppressive drugs and reproduction.
Arthritis Res Ther, 8 (2006), pp. 209-228
[53.]
T.F. Yeh, Y.J. Lin, H.C. Lin, C.C. Huang, W.S. Hsieh, C.H. Lin, et al.
Outcomes at school age after postnatal dexamethasone therapy for lung disease of prematurity.
N Engl J Med, 350 (2004), pp. 1304-1313
[54.]
G. Ruiz-Irastorza, F. Lima, J. Alves, M.A. Khamashta, J. Simpson, G.R. Hughes, et al.
Increased rate of lupus flare during pregnancy and the puerperium: a prospective study of 78 pregnancies.
Br J Rheumatol, 35 (1996), pp. 133-138
[55.]
M. Petri, D. Howard, J. Repke.
Frequency of lupus flare in pregnancy The Hopkins Lupus Pregnancy Center experience.
Arthritis Rheum, 34 (1991), pp. 1538-1545
[56.]
G. Ruiz-Irastorza, M.A. Khamashta.
Management of thrombosis in antiphospholipid syndrome and systemic lupus erythematosus in pregnancy.
Ann N Y Acad Sci, 1051 (2005), pp. 606-612
Los autores declaran no presentar ningún conflicto de interés al momento de la redacción del manuscrito.
Profesor asistente. Sección de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
Profesor auxiliar. Sección de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
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