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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(04): 209-224
DOI: 10.1055/s-0038-1625951
Review Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

Uma Revisão Crítica Sobre o Acompanhamento Obstétrico de Mulheres com Lúpus Eritematoso Sistêmico
Danilo Eduardo Abib Pastore
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
,
Maria Laura Costa
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
,
Mary Angela Parpinelli
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
,
Fernanda Garanhani Surita
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

01. November 2017

20. Dezember 2017

Publikationsdatum:
27. April 2018 (online)

   Lizenzen und Reprints

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 heart-block) 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.

Resumo

Objetivo Revisar as recomendações existentes sobre o cuidado pré-natal às mulheres com lúpus eritematoso sistêmico (LES), com base em evidências científicas atualmente disponíveis.

Métodos Revisão integrativa realizada por dois pesquisadores independentes, com base na literatura disponível nos bancos de dados MEDLINE (via PubMed), EMBASE e The Cochrane Library, usando os cabeçalhos de assuntos médicos, ou termos MeSH, “systemic lupus erythematosus” E “high-risk pregnancy” OU “prenatal care.” Estudos publicados em inglês entre 2007 e 2017 foram incluídos; estudos experimentais e relatos de caso foram excluídos. Em caso de desacordo, um terceiro pesquisador sênior foi consultado. Quarenta títulos foram inicialmente identificados; quatro duplicatas foram excluídas. Após leitura dos resumos, mais 7 artigos foram excluídos e 29 foram selecionados para uma avaliação de texto completo.

Resultados Surtos de LES, pré-eclâmpsia, perda de gestação, parto prematuro, restrição de crescimento fetal e síndromes de lúpus neonatal foram as principais complicações descritas. A equipe multidisciplinar deve adotar um monitoramento específico, com protocolos terapêuticos apropriados. Há drogas seguras e eficazes que devem ser prescritas para um bom controle do LES.

Conclusão Gestantes com LES apresentam risco aumentado de complicações maternas, perda de gravidez e outros desfechos adversos. A atividade da doença pode piorar e, assim, aumentar o risco de outras complicações. Assim, manter um controle adequado da atividade da doença e tratar rapidamente os surtos deve ser um objetivo central durante o pré-natal.

Keywords

systemic lupus erythematosus - pregnancy - prenatal care - maternal outcomes - fetal outcomes

Palavras-chave

lúpus eritematoso sistêmico - gravidez - cuidado pré-natal - resultados maternos - resultados fetais
 

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