Lupus eritematoso sistemico y embarazo, descripcion de las complicaciones, seguimiento y particularidades del manejo en la etapa gestacional de un problema clinico complejo
Resumen
El LES es una enfermedad autoinmune multisistémica que afecta predominantemente a mujeres en edad reproductiva, lo que plantea desafíos adicionales debido a las complicaciones materno-fetales. Las principales complicaciones incluyen el parto prematuro, la preeclampsia y el síndrome antifosfolípido, entre otros, los cuales pueden aumentar el riesgo de pérdida fetal, crecimiento intrauterino retardado y complicaciones neonatales como el bloqueo cardíaco congénito. El manejo adecuado del LES en el embarazo requiere una planificación cuidadosa, control prenatal riguroso y un enfoque multidisciplinario. Se destaca el uso de medicamentos como la hidroxicloroquina para reducir la actividad de la enfermedad y los riesgos asociados, mientras que otros tratamientos deben evitarse debido a sus efectos teratogénicos. En el postparto, la lactancia materna se considera segura, y las complicaciones neonatales como el lupus neonatal suelen resolverse sin necesidad de intervención adicional.
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Stojan G, Petri M. Epidemiology of systemic lupus erythematosus: an update. Curr Opin Rheumatol. 2018;30(2):144–50.
Yu C, Gershwin ME, Chang C. Diagnostic criteria for systemic lupus erythematosus: a critical review. J Autoimmun. 2014;48–49:10–3.
Petri M, Orbai AM, Alarcon GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classifcation criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64(8):2677–86.
Malaviya AN, Chandrasekaran AN, Kumar A, et al. Systemic lupus erythematosus in India. Lupus. 1997;6(9):690–700.
Malaviya AN, Singh RR, Singh YN, et al. Prevalence of systemic lupus erythematosus in India. Lupus. 1993;2(2):115–8.
Lim SS, Drenkard C. Epidemiology of lupus: an update. Curr Opin Rheumatol. 2015;27(5):427–32.
Wallace DJ, Hahn BH. Dubois’ lupus erythematosus and related syndromes. 8th ed. Amsterdam: Saunders Elsevier; 2013.
Clark CA, Spitzer KA, Laskin CA. Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40-year period. J Rheumatol. 2005;32(9):1709–12.
Petri M, Daly RP, Pushparajah DS. Healthcare costs of pregnancy in systemic lupus erythematosus: retrospective observational analysis from a US health claims database. J Med Econ. 2015;18(11):967–73.
Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum. 2006;54(3):899–907.
Clowse ME, Jamison M, Myers E, et al. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199(2):127.e1–6.
Yan Yuen S, Krizova A, Ouimet JM, et al. Pregnancy outcome in systemic lupus erythematosus (SLE) is improving: results from a case control study and literature review. Open Rheumatol J. 2008;2:89–98.
Clark CA, Spitzer KA, Nadler JN, et al. Preterm deliveries in women with systemic lupus erythematosus. J Rheumatol. 2003;30(10):2127–32.
Clowse ME, Wallace DJ, Weisman M, et al. Predictors of preterm birth in patients with mild systemic lupus erythematosus. Ann Rheum Dis. 2013;72(9):1536–9.
Lateef A, Petri M. Systemic lupus erythematosus and pregnancy. Rheum Dis Clin North Am. 2017;43(2):215–26.
Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of preeclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):391–403.
Chakravarty EF, Colon I, Langen ES, et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol. 2005;192(6):1897–904.
Kuc S, Wortelboer EJ, van Rijn BB, et al. Evaluation of 7 serum biomarkers and uterine artery Doppler ultrasound for frst-trimester prediction of preeclampsia: a systematic review. Obstet Gynecol Surv. 2011;66(4):225–39.
Gomez-Puerta JA, Cervera R. Diagnosis and classifcation of the antiphospholipid syndrome. J Autoimmun. 2014;48–49:20–5.
Levy RA, Dos Santos FC, de Jesus GR, et al. Antiphospholipid antibodies and antiphospholipid syndrome during pregnancy: diagnostic concepts. Front Immunol. 2015;7(6):205.
Eudy AM, Siega-Riz AM, Engel SM, et al. Efect of pregnancy on disease fares in patients with systemic lupus erythematosus. Ann Rheum Dis. 2018;77(6):855–60.
Smyth A, Oliveira GH, Lahr BD, et al. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol. 2010;5(11):2060–8.
Imbasciati E, Tincani A, Gregorini G, et al. Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome. Nephrol Dial Transplant. 2009;24(2):519–25.
Gladman DD, Tandon A, Ibanez D, et al. The efect of lupus nephritis on pregnancy outcome and fetal and maternal complications. J Rheumatol. 2010;37(4):754–8.
Petri M, Howard D, Repke J. Frequency of lupus fare in pregnancy. The Hopkins Lupus Pregnancy Center experience. Arthritis Rheum. 1991;34(12):1538–45.
Wagner SJ, Craici I, Reed D, et al. Maternal and foetal outcomes in pregnant patients with active lupus nephritis. Lupus. 2009;18(4):342–7.
Petri M. The Hopkins Lupus Pregnancy Center: ten key issues in management. Rheum Dis Clin North Am. 2007;33(2):227–35.
Buyon JP, Kim MY, Guerra MM, et al. Kidney outcomes and risk factors for nephritis (fare/de novo) in a multiethnic cohort of pregnant patients with lupus. Clin J Am Soc Nephrol.
2017;12(6):940–6.
Vanoni F, Lava SAG, Fossali EF, et al. Neonatal systemic lupus erythematosus syndrome: a comprehensive review. Clin Rev Allergy Immunol. 2017;53(3):469–76.
Klein-Gitelman MS. Neonatal lupus: what we have learned and current approaches to care. Curr Rheumatol Rep. 2016;18(9):60-016-0610-z.
Brito-Zeron P, Izmirly PM, Ramos-Casals M, et al. The clinical spectrum of autoimmune congenital heart block. Nat Rev Rheumatol. 2015;11(5):301–12.
Brito-Zeron P, Izmirly PM, Ramos-Casals M, et al. Autoimmune congenital heart block: complex and unusual situations. Lupus. 2016;25(2):116–28.
Sonesson SE. Diagnosing foetal atrioventricular heart blocks. Scand J Immunol. 2010;72(3):205–12.
Pieper PG, Hoendermis ES. Pregnancy in women with pulmonary hypertension. Neth Heart J. 2011;19(12):504–8.
Hladunewich M, Hercz AE, Keunen J, et al. Pregnancy in end stage renal disease. Semin Dial. 2011;24(6):634–9.
Grewal J, Silversides CK, Colman JM. Pregnancy in women with heart disease: risk assessment and management of heart failure. Heart Fail Clin. 2014;10(1):117–29.
Aydin S, Ersan F, Ark C, et al. Partial HELLP syndrome: maternal, perinatal, subsequent pregnancy and long-term maternal outcomes. J Obstet Gynaecol Res. 2014;40(4):932–40.
Eudy AM, Siega-Riz AM, Engel SM, et al. Preconceptional cardiovascular health and pregnancy outcomes in women with systemic lupus erythematosus. J Rheumatol. 2018;46:70.
Guillotin V, Bouhet A, Barnetche T, et al. Hydroxychloroquine for the prevention of fetal growth restriction and prematurity in lupus pregnancy: a systematic review and meta-analysis. Joint Bone Spine. 2018;85:663.
Izmirly PM, Kim MY, Llanos C, et al. Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine. Ann Rheum Dis. 2010;69(10):1827–30.
Izmirly PM, Costedoat-Chalumeau N, Pisoni CN, et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation. 2012;126(1):76–82.
Levy RA, Vilela VS, Cataldo MJ, et al. Hydroxychloroquine (HCQ) in lupus pregnancy: double-blind and placebo-controlled study. Lupus. 2001;10(6):401–4.
Saxena A, Izmirly PM, Mendez B, et al. Prevention and treatment in utero of autoimmune-associated congenital heart block. Cardiol Rev. 2014;22(6):263–7.
Noviani M, Wasserman S, Clowse ME. Breastfeeding in mothers with systemic lupus erythematosus. Lupus. 2016;25(9):973–9.
Petri M. Pregnancy and Systemic Lupus Erythematosus. Best Pract Res Clin Obstet Gynaecol. 2020 Apr;64:24-30. doi: 10.1016/j.bpobgyn.2019.09.002. Epub 2019 Oct 8. PMID: 31677989.
Moyer A, Chakravarty EF. Management of Pregnancy in Lupus. Rheum Dis Clin North Am. 2021 Aug;47(3):441-455. doi: 10.1016/j.rdc.2021.04.008. Epub 2021 Jun 16. PMID: 34215373.
Fischer-Betz R, Haase I. Schwangerschaft bei Lupus erythematodes – ein Update [Pregnancy with lupus erythematosus-an update]. Z Rheumatol. 2020 May;79(4):359-366. German. doi: 10.1007/s00393-020-00772-9. PMID: 32236845.
Parikh SV, Almaani S, Brodsky S, Rovin BH. Update on Lupus Nephritis: Core Curriculum 2020. Am J Kidney Dis. 2020 Aug;76(2):265-281. doi: 10.1053/j.ajkd.2019.10.017. Epub 2020 Mar 24. PMID: 32220510.
Rajendran A, Eudy AM, Balevic SJ, Clowse MEB. The importance of pregnancy planning in lupus pregnancies. Lupus. 2021 Apr;30(5):741-751. doi: 10.1177/0961203321989803. Epub 2021 Jan 28. PMID: 33509066; PMCID: PMC8026487.
Fanouriakis A, Kostopoulou M, Cheema K, Anders HJ, Aringer M, Bajema I, Boletis J, Frangou E, Houssiau FA, Hollis J, Karras A, Marchiori F, Marks SD, Moroni G, Mosca M, Parodis I, Praga M, Schneider M, Smolen JS, Tesar V, Trachana M, van Vollenhoven RF, Voskuyl AE, Teng YKO, van Leew B, Bertsias G, Jayne D, Boumpas DT. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis. 2020 Jun;79(6):713-723. doi: 10.1136/annrheumdis-2020-216924. Epub 2020 Mar 27. PMID: 32220834.
Derechos de autor 2024 Luigi Santucci Chacón , Juan Camilo Velásquez Rodríguez, Jesús David González Martínez , Laura Kamila Pérez Alquichire , Karina Estefany González Fuentes, Paula Andrea Boada Pérez , José Andrés González Martínez, María Paula Meléndez Pedraza , Juan Nicolas Ortiz Beltran , Diego Antonio Medina Ardila, Laritza Johana Pérez Ardila
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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