Lupus eritematoso sistêmico e gravidez
Palavras-chave:
lupus eritematoso sistemico, complicações na gravidez, gestação de alto risco, assistencia perinatalResumo
O lupus eritematoso sistêmico é uma doença auto-imune de etiologia desconhecida que acomete preferencialmente mulheres em idade reprodutiva. Assim, sua presença no ciclo grávido-puerperal é relativamente freqüente e tem aumentado nas últimas décadas. Existe o risco da gravidez sobre a doença, principalmente por conta das alterações hormonais nessa fase da vida da mulher, propiciando reativação da doença; porém, sem dúvida são maiores os riscos da doença sobre a gravidez, neste caso por conta de maus resultados perinatais e maior ocorrência de complicações maternas como a pré-eclâmpsia. O tratamento da doença na gestação deve levar em conta tanto o risco do uso da medicação imunossupressora, como o risco da atividade da doença. O seguimento desses casos deve ser multidisciplinar para alcançar os melhores resultados maternos e perinatais.
Downloads
Referências
Lahita RG. The role of sex hormones in systemic lupus erythematosus. Curr Opin Rheumatol 1999; 11 (5):352-6.
Carmona F, Font J, Cervera R, Munõz F, Cararach V, Balash J. Obstetrical outcome of pregnancy in patients with systemic Lupus Erythematosus. A study of 60 cases. Eur J Obstet Gynecol Reprod Biol 1999; 83:137-42.
Hochberg M. Updating the American College of Reumathology Revised Criteria for the Classification of Systemic Lupus Erythematosus. Arthritis Rheum 1997; 40(9): 1725.
Tan EM, Cohen AS, Fries JF , Masi AT, McShane DJ, Rothfield NF, et ai. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 2 5(11 ): 1271-7.
Mintz G, Niz J, Gutierrez G, et ai. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach. J Rheumatol 1986; 13:4.
Cunninghan FG, Gant NF, Leveno KJ, Gelstap LC, Hauth JC, Wenstom KD. Connective-tissue disorders. ln: Williams Obstetrics. 21th ed. New York: MacGraw-Hill; 2001.
Lockshin, MD. Pregnancy does not cause SLE to worsen. Arthritis Rheum 1989; 32:665.
Guballa N, Sammaritano L, Schwartzman S, et ai. Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome. Arthritis Rheum 2000; 43:550.
Julkunen H, Kaaja R, Palosuo T, Gronhagen-Riska C, Teramo K. Pregnancy in lup.us nephropathy. Acta Obstet Gynecol Scand 1993; 72:258.
Bobrie G, Liote F, Houillier P, et ai. Pregnancy in lupus nephritis and related disorders. Am J Kidney Dis 1987; 9:339.
Buyon JP, Tamerius J, Ordorica S, et ai. Activation of the alternative complement pathway accompanies disease fiares in systemic lupus erythematosus during pregnancy. Arthritis Rheum 1992; 35:55.
Repke JT. Hypertensive dis_orders of pregnancy. Differentiating preeclampsia from active systemic lupus erythematosus. J Reprod Med 1998; 43:350.
Petri M, Albritton J. Fetal outcome of lupus pregnancy: a retrospective case-control study of the Hopkins lupus cohort. J Rheumatol 1993; 20:650.
Bermas BL, Shur, PH. Clinicai manifestation and diagnosis of the antiphospholipid antibody syndrome. Wellesley, MA: UpToDate®; ©2003 [cited 2004 Jun 16]. Available from:_http:// www.uptodate.com
Kutteh WH, Rote NS ,ilver R. Antiphospholipid antibodies and reproduction: the antiphospholipid antibody syndrome. Am J Reprod lmmunol 1999; 41(2): 133-52.
Brucato A, 1Franceschini F, Buyon JP. Neonatal lupus: long-term outcomes of mothers and children and recurrence fate. Clin Exp Rheumatol 1997; 15:467
Buyon JP, Hiebert R, Cljlel J, Craft J, Friedman D, Katholi M, et ai. Autoimmune-associated congenital heart block: demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J Am Coll Cardiol 1995; 31 (7): 1658-66.
Salomonsson S, Dorner T, Theander E, Bremme K, Larsson P, Wahren-Herlenius A. Serologic marker for fetal risk of congenital heart block.AL!_ MSO. Arthritis Rheum 2002; 46(5): 1233-41.
Carmichael SL, Shaw GM. Maternal corticosteroid use and risk of selected congenital anomalies.AU. Am J Med Genet 1999; 86(3):242-4.
Bonnie L, Bermas MD. Use of immunosuppressive drugs in pregnancy. Wellesley, MA: UpToDate; 2003 [cited 2004 Jun 16]. Available from: http://www.uptodate.com
Armenti VT, Ahlswede KM, Ahlswede BA, Jarrell BE, Moritz MJ, Burke JF. National transplantation Pregnancy Registry-outcomes of 154 pregnancies in cyclosporine-treated female kidney transplant recipients. Transplantion 1994; 57(4):502-6.
Khamashta MA, Buchanan NM, Hughes GR. The use of hydroxychloroquine in lupus pregnancy: the British experience. Lup_us 1996; 5 Suppl > 1 :S65-6.
Seo P, Stone JH. Mycophenolate in the treatment of rheumatic diseases. Wellesley, MA: UpToDate; 2003 [cited 2004 Jun 16). Available from: http://wvvw.uptodate.com
