妊娠与风湿免疫性疾病

Pregnancy and Rheumatic Diseases

风湿免疫性疾病主要累及育龄期女性,故妊娠是风湿免疫性疾病诊治不可回避的问题。除炎性关节炎之外,多数活动性风湿免疫性疾病患者妊娠均可引起病情恶化,先兆子痫等严重的产科并发症和胎儿不良结局的发生率增加。因此关键在于妊娠前保证风湿免疫性疾病的病情得到良好控制。另外,治疗风湿免疫性疾病所必需的多种抗炎药和免疫抑制剂可能导致患者不孕不育和胎儿不良结局。本文对风湿免疫性疾病妊娠相关合并症和妊娠及哺乳期安全用药进行综述。

Pregnancy is an issue that should be discussed with patients with rheumatic diseases because these diseases mainly involve women of reproductive age. Except for inflammatory arthritis, most active rheumatic diseases may be at increased risk of deterioration in pregnancy. Critical maternal complications （such as pre-eclampsia） and poor fetal outcome are common. It is important to ensure that rheumatic diseases are well controlled prior to pregnancy. Meanwhile, some anti-inflammatory and immunosuppressive drugs necessitated to control rheumatic diseases during pregnancy can be associated with increased risk of infertility and poor fetal outcome. This article will briefly review the important issues in pregnancies comphcated by rheumatic diseases and provide a general recommendation to physicians for drug treatment during pregnancy and lactation.