Rheumatische Erkrankungen und Schwangerschaft

Zusammenfassung

Durch Schwangerschaft und Wochenbett kann die Aktivität der rheumatischen Erkrankung beeinflusst werden. In prospektiven Studien zeigte sich, dass bei der Rheumatoiden Arthritis in zwei Dritteln bis drei Vierteln der Fälle eine Verbesserung der Arthritis in der Schwangerschaft eintritt. Post partum kommt es jedoch zur Exazerbation. Bei den Spondylarthritiden zeigt sich keine wesentliche Veränderung der rheumatischen Aktivität. Auch beim systemischen Lupus erythematodes ist - nur unter Beachtung eines günstigen Schwangerschaftszeitpunktes - nicht mit verstärkter Flare-Neigung zu rechnen. Kontraindikationen einer Schwangerschaft müssen jedoch unbedingt berücksichtigt werden. Die fetale Prognose ist bei aktiver rheumatischer Erkrankung und besonders bei Patienten mit systemischem Lupus erythematodes beeinflusst. Sie hängt vom Aktivitätsgrad der Grunderkrankung der Mutter ab. In jedem Falle ist die Schwangerschaft einer Rheumatikerin eine Risikoschwangerschaft und bedarf der engen Zusammenarbeit zwischen Rheumatologen und Geburtshelfer.

Abstract

The activity of a rheumatic disease can be influenced by pregnancy and puerperium. Prospective studies described an improvement of arthritis in rheumatoid arthritis in two-thirds to three-quarters of the pregnancies. After birth an exacerbation occurs. In spondylarthropathies there is no relevant change in disease activity. In systemic lupus erythematosus the risk of flares is not increased if a favourable time for pregnancy is expected. Nevertheless, the contraindications for pregnancy must be taken into account. The foetal prognosis is influenced by an active rheumatic disease, particularly in patients with systemic lupus erythematosus. This depends on the maternal disease activity. Any case of pregnancy in rheumatic women is a high-risk pregnancy with the need for close collaboration between rheumatologists and obstetricians.

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