SLE
A woman with systemic lupus erythematosus presents in the fifteenth week of her second pregnancy.
Does SLE have any impact on pregnancy?
SLE女性患者，第二次妊娠，孕15周：
SLE对妊娠的影响？
参考答案：
SLE对妊娠的影响？
SLE是一种多系统疾患，常对处于分娩期的女性造成影响。SLE的发病率似乎呈增加趋势，但是大多数学者认为这是因为对轻微症状SLE的诊断得到提高所致。该疾患的发病率，非洲女性显著高于白人女性，分别为1/245和1/700[1]。一般来说，生育能力并不会受到影响，除非在需要进行有效治疗的严重疾患者[2]。
该疾患常表现出多种症状，可能包括多个器官系统的损害，机体内常含有针对不同细胞核成分（如细胞质、细胞膜）的抗体。不同患者抗体不同，这些差异可能成为不同临床表现的原因。
妊娠不会影响SLE的长期疾病进程，但可能与短期发作有关。SLE的存在增加晚期妊娠流产的可能性，因为高血压、肾功能衰竭或羊膜早破。患SLE的女性分娩时妊娠时间明显缩短，剖宫产术的几率也明显增加。慢性高血压、肾疾患和胎儿生长受限的可能性增加，母体产后出血和深静脉血栓形成几率增加[3]。
胎儿和新生儿结局不良，包括胎儿和新生儿死亡率较高。特别是本病表现为包括抗磷脂综合征时，胎儿死亡和习惯性流产的发生率很高。再次发生妊娠流产的可能性为妊娠女性的1%，但这些女性的40%有抗磷脂综合征[4]。有这种综合症的部分女性存在SLE。妊娠期间这些女性的治疗包括阿司匹林、类固醇或肝素将改善母体的愈后、促进胎儿存活率[5]。然而，在不患有SLE的抗磷脂综合征女性，支持疗法似乎具有与阿司匹林治疗可降低胎儿死亡率的效果[6]。这些结果表明，关于该疾患以及对妊娠和妊娠女性的影响仍不完全清楚。同时，SLE对胎儿和新生儿的影响复杂，并有多种表现，最显著的是表现为皮肤损害和心律失常。
Does SLE have any impact on pregnancy?
Systemic lupus erythematosus is a multi-system disease, usually affecting women of childbearing age. The prevalence seems to be increasing, although most authors think that this is due to improved diagnosis of milder presentations of the disease. The disease is more common in African American women than Caucasian women, with a prevalence of between 1/245 and 1/700 (1). In general, fertility is not impacted by the disease except in severe cases requiring more potent therapy, so it occurs commonly during pregnancy (2).
The disease is characterized by a multitude of manifestations that may involve almost any organ system and by the presence of antibodies to different components of the cell nucleus as well as the cytoplasm and cell membrane. Different patients may have different antibodies and it is possible that these differences explain the different clinical manifestations.
Pregnancy does not affect the long-term course of the disease, but may be associated with flare-ups. The presence of the disease increases the likelihood of late pregnancy loss due to hypertension, renal dysfunction or premature rupture of the membranes. Women with the disease deliver at significantly lower average gestational age, and are more likely to have Cesarean sections. Rates of chronic hypertension, renal disease, and fetal growth restriction are increased, as are maternal postpartum hemorrhage and deep vein thrombosis (3).
Fetal and neonatal outcomes are worse, including higher rates of fetal and neonatal deaths. In particular forms of the disease, including the antiphospholipid syndrome, the rate of fetal loss and recurrent abortions is very high. Recurrent pregnancy loss occurs in about 1% of pregnant women, but as many as 40% of these women have antiphospholipid syndrome (4). Some of the women with this syndrome have SLE. For these women therapy during pregnancy with aspirin, steroids or heparin will improve maternal outcome, and may improve fetal outcome (5) as well. However, in the group of women with antiphospholipid syndrome and no SLE, supportive care appears to be as effective as aspirin therapy in reducing fetal loss (6). These studies illustrate that much remains to be ununderstood about these disorders and their impact on pregnancy and pregnant women. At the same time, SLE can have a profound impact on the fetus and neonate, including a variety of manifestations. Most prominently, these include skin lesions and cardiac rhythm disturbances.
References:
1. Fessel WJ. Systemic lupus erythematosus in the community: Incidence, prevalence, outcome and first symptoms. The high prevalence in black women. Arch Intern Med. 1974; 134:1027.
2. McDermot EM, Powell RJ. Incidence of ovarian failure in systemic lupus erythematosus after treatment with pulse cyclophosphamide. Ann Rheum Dis 1996; 55:224.
3. Yasmeen S, Eby-Wilkens E, Gilbert WM. Pregnancy outcome in women with systemic lupus erythematosus. Am J Ob Gyn 2000; 182:S165.
4. Pattison NS, Birdsall MA, Chamley LW, et al. Recurrent fetal loss and the anti-phospholipid syndrome. Recent Adv Obstet Gynaecol. 1994;18:23.
5. Kutteh WH. Anti-phospholipid antibody associated recurrent pregnancy loss: treatment with heparin and low dose aspirin is superior to low dose aspirin alone. Am J Obstet Gynecol. 1996;174:1584.
6. Pattison NS, Chamley LW, Birdsall M, et al. Does aspirin have a role in improving pregnancy outcome for women with the antiphospholipid syndrome? A randomized controlled trial. Am J Obstet Gynecol 2000, 183:1008.
编辑：ache
