A Critical Review on Obstetric Follow-up ofWomen Affected by Systemic Lupus Erythematosus

Abstract Objective To review the existing recommendations on the prenatal care of women with systemic lupus erythematosus (SLE), based on currently available scientific evidence. Methods An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed), EMBASE and The Cochrane Library databases, using the medical subject headings (MeSH) terms “systemic lupus erythematosus” AND “high-risk pregnancy” OR “prenatal care.” Studies published in English between 2007 and 2017 were included; experimental studies and case reports were excluded. In cases of disagreement regarding the inclusion of studies, a third senior researcher was consulted. Forty titles were initially identified; four duplicates were excluded. After reading the abstracts, 7 were further excluded and 29 were selected for a full-text evaluation. Results Systemic lupus erythematosus flares, preeclampsia, gestation loss, preterm birth, fetal growth restriction and neonatal lupus syndromes (mainly congenital heartblock) were the major complications described. The multidisciplinary team should adopt a specific monitoring, with particular therapeutic protocols. There are safe and effective drug options that should be prescribed for a good control of SLE activity. Conclusion Pregnant women with SLE present an increased risk for maternal complications, pregnancy loss and other adverse outcomes. The disease activity may worsen and, thereby, increase the risk of other maternal-fetal complications. Thus, maintaining an adequate control of disease activity and treating flares quickly should be a central goal during prenatal care.

摘要 目的 本研究旨在基于现有科学证据，系统回顾针对系统性红斑狼疮（systemic lupus erythematosus, SLE）孕妇的产前护理现有指南。
方法 本研究由两名独立研究员开展整合性综述研究，检索MEDLINE（通过PubMed）、EMBASE及Cochrane图书馆数据库中的文献，采用医学主题词（Medical Subject Headings, MeSH）检索式：“systemic lupus erythematosus” AND “high-risk pregnancy” OR “prenatal care”。纳入2007至2017年发表的英文文献，排除实验性研究及病例报告。若对文献纳入存在分歧，则咨询第三位资深研究员。初步检索共获得40篇文献，剔除4篇重复文献。阅读摘要后，进一步排除7篇，最终筛选29篇进行全文评估。
结果 本研究描述的主要并发症包括系统性红斑狼疮发作、子痫前期、妊娠丢失、早产、胎儿生长受限及新生儿狼疮综合征（主要为先天性心脏传导阻滞）。多学科团队应采用针对性监测方案与特定治疗策略。现有安全有效的药物选择可用于良好控制系统性红斑狼疮的疾病活动度。
结论 系统性红斑狼疮孕妇发生母体并发症、妊娠丢失及其他不良妊娠结局的风险显著升高。疾病活动度可能出现加重，进而增加其他母胎并发症的发生风险。因此，在产前护理过程中，充分控制疾病活动度并快速干预疾病发作应作为核心目标。