Průběh těhotenství u žen se systémovýmlupus erythematodes nebos antifosfolipidovým syndromem

Course of Pregnancy in Women with Systemic Lupus Erythemato-sus or Antiphospholipid Syndrome

Objective:
The objective of the investigation was to follow up the course of pregnancy in 32 womenwith systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) and to evaluateselected clinical and laboratory parameters. Method: Clinical status, total SLE activity accordingto the SLEDAI score, treatment during pregnancy and selected haematological, biochemical andimmunological parameters were investigated. The patients were examined before conception, atthe onset of pregnancy and then after each trimester of pregnancy, and immediately after delivery.Results: Eighteen of the patients suffered from SLE, five had SLE with secondary APS and ninepatients had primary APS. The majority of patients with SLE was treated with a small dose ofcorticosteroids, patients with APS took small doses of anopyrin as antiaggregation therapy. Thetotal SLE activity was in the great majority of patients low, as apparent also from the low values ofthe SLEDAI score. Organ manifestation of SLE was present in two patients. All women with primaryAPS and 21 women with SLE had a pregnancy without complications and in term gave birth toa healthy child. These patients had at the onset and in the course of pregnancy a low clinical andlaboratory activity of the disease and had no significant organ manifestations of SLE. Two womendeveloped a serious life threatening exacerbation of the disease with severe manifestations of lupusnephritis with acute risk of survival of the foetuses. Both these patients had to be treated duringpregnancy by combined immunosuppressive treatment, and premature delivery had to be induced.One of the neonates died on the fourth day, the second one survives and is doing well. Conclusion:Pregnancy took a normal course without complications and without exacerbation of the disease inall patients with primary APS and in 21 patients with SLE (without or with secondary APS), whohad at the time of conception a low activity of the disease. In two patients with SLE who had alsoa low activity of the disease before conception exacerbation of SLE occurred during pregnancy withserious organ manifestation. Pregnancy was very complicated in these women, both had prematuredeliveris and one of the neonates died because of immaturity. Increased activity of SLE and the presence of organ manifestations during pregnancy were in the investigated group importantpredictors of the development of SLE as well as of the whole course of pregnancy.

Key words:
systemic lupus erythematosus, antiphospholipid syndrome, pregnancy, exacerbati-on of activity of the disease, organ manifestation