• Prevention of reproductive losses in women with systemic lupus erythematosus

Prevention of reproductive losses in women with systemic lupus erythematosus

PERINATOLOGIYA I PEDIATRIYA. 2016.4(68):26-32; doi 10.15574/PP.2016.68.26 
 

Prevention of reproductive losses in women with systemic lupus erythematosus


Davydova I., Shevchuk E., Limanskaya A., Ogorodnyk A.

SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv


Purpose — to explore the peculiarities of pregnancy and childbirth in women with systemic lupus erythematosus in view of pregravid preparation.


Patients and methods. The study included three groups. I group — 24 pregnant women with systemic lupus erythematosus who received pregravid preparation, group II of 28 pregnant women with systemic lupus erythematosus, have spontaneously pregnancy, III — control group 28 pregnant women without autoimmune diseases. Groups comparable in age, education, eating habits and living in similar climatic conditions. In pregravid preparations include micronized progesterone (utrozhestan in a daily dose of 200 mg of 16 to 25 days of the cycle) when detecting failure II cycle phase — Tivortin in therapeutic dosage, drug containing iodine and folic acid at daily dosages recommended by WHO for preconception period (respectively, 200 mg and 400 mg).


Results. In all three groups there were no spontaneous termination of pregnancy up to 12 weeks. In the first group shows significantly better results when comparing the frequency of pregnancy complications, pregnancy outcomes, metabolic disorders. Conduct prevention of endothelial dysfunction drug Tivortin and continued therapy support L-arginine in the early stages of gestation, in groups of pregnant women with high titers of anti-Ro antibodies, antiphospholipid antibodies, along with prolonged intake of micronized progesterone (utrozhestan), helped to reduce the incidence of hypertensive complications of pregnancy (gestational hypertension, pre!eclampsia) and the birth of children with IUGR or low birth weight for gestational age. Group II women were not able to modify the drug therapy. Pregnant women in this group were receiving corticosteroids due to activation of an autoimmune disease. In some women was the need to enhance the treatment of SLE with corticosteroids in pulse mode using a 2-line therapy in the postpartum period.


Conclusions. Pregnancy in women with systemic lupus erythematosus is a complex task. Women of childbearing age with systemic lupus erythematosus is strongly recommended that preconception counseling and individual approach to the assessment of the risks of obstetric and somatic complications. Multidisciplinary team should be experience of rare, severe extragenital diseases. Pregravid preparation should be used for the preparation of micronized progesterone vaginal administration (utrozhestan). Careful planning pregnancy with specialized experts with experience in the management of these patients, a reasonable pregravid preparation, timely detection of risk factors and prevention of obstetric, somatic and perinatal complications, can achieve success and minimize the maternal and perinatal complications.


Key words: systemic lupus erythematosus, a pregnancy, a multidisciplinary approach, Tivortin, micronized progesterone, Utrozhestan.


References

1. Clowse ME, Jamison M, Myers E, James AH. 2008.A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 199(2): 127. https://doi.org/10.1016/j.ajog.2008.03.012; PMid:18456233 PMCid:PMC2542836

2. Coomarasamy A et al. 2015. A Randomized Trial of Progesterone in Women with Recurrent Miscarriages. N Engl J Med. 373: 2141—2148. https://doi.org/10.1056/NEJMoa1504927.

3. Antiphospholipid syndrome: practice bulletin No.118; American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics. Obstet. Gynecol. 2011. 117: 192—199. https://doi.org/10.1097/AOG.0b013e31820a61f9; PMid:21173671

4. Koniari I, Siminelakis SN, Baikoussis NG et al. 2010. Antiphospholipid syndrome; its implication in cardiovascular diseases: a review. J Cardiothorac Surg. 5: 101. https://doi.org/10.1186/1749-8090-5-101; PMid:21047408 PMCid:PMC2987921

5. Baker ME. 2011. Origin and diversification of steroids: co-evolution of enzymes and nuclear receptors. Mol Cell Endocrinol. 334: 14—20. https://doi.org/10.1016/j.mce.2010.07.013; PMid:20654689

6. Kelder J, Azevedo R, Pang Y et al. 2010. Comparison between steroid binding to membrane progesterone receptor alpha(mPRalpha) and to nuclear progesterone receptor: Correlation with physicochemical properties assessed by comparative molecular field analysis and identification of mPRalpha-specific agonists. Steroids. 75: 314—322. https://doi.org/10.1016/j.steroids.2010.01.010; PMid:20096719 PMCid:PMC2858063

7. Evaluation and treatment of recurrent pregnancy loss: A committee opinion. Practice Committee of the American Society for Reproductive Medicine. Fertil Steril. 2012. 98: 1103—1111. https://doi.org/10.1016/j.fertnstert.2012.06.048; PMid:22835448

8. Saavedra MA, Cruz-Reyes C, Vera-Lastra O et al. 2012. Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy. Clinical rheumatology. 31(5): 813—819. https://doi.org/10.1007/s10067-012-1941-4; PMid:22278163

9. Lateef A, Petri M. 2012. Management of pregnancy in systemic lupus erythematosus. Nat Rev Rheumatol. 8(12): 710—718. https://doi.org/10.1038/nrrheum.2012.133; PMid:22907290

10. McNamee K, Dawood F, Farquharson R. 2012. Recurrent miscarriage and thrombophilia: An update. Curr Opin Obstet Gynecol. 24: 229—234. https://doi.org/10.1097/GCO.0b013e32835585dc; PMid:22729089

11. Lo YM et al. 2000. Quantitative analysis of the bidirectional fetomaternal transfer of nucleated cells and plasma DNA. Clin Chem. 46(9): 1301—1309. PMid:10973858

12. Gonzalez DA, Diaz BB, Perez MR et al. 2010. Sex hormones and autoimmunity. Immunol Lett. 133: 6—13. https://doi.org/10.1016/j.imlet.2010.07.001; PMid:20637236

13. Martocchia A, Stefanelli M, Cola S, Falaschi P. 2011. Sex steroids in autoimmune diseases. Curr Top Med Chem. 11: 1668—1683. https://doi.org/10.2174/156802611796117595; PMid:21463254

14. Clowse ME, Chakravarty E, Costenbader KH et al. 2012. The effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken).

15. Conde-Agudelo A, Romero R, Nicolaides K et al. 2013. Vaginal progesterone vs. cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: A systematic review and indirect comparison metaanalysis. Am J Obstet Gynecol. 208: 42. https://doi.org/10.1016/j.ajog.2012.10.877; PMid:23157855 PMCid:PMC3529767

16. Alfirevic Z, Owen J, Carreras Moratonas E et al. 2013. Vaginal progesterone, cerclage or cervical pessary for preventing pre-term birth in asymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix. Ultrasound Obstet Gynecol. 41: 146—151. https://doi.org/10.1002/uog.12300; PMid:22991337

17. Weckerle CE, Niewold TB. 2011. The Unexplained Female Predominance of Systemic Lupus Erythematosus: Clues from Genetic and Cytokine Studies. Clin Rev Allergy Immunol. 40: 42—49. https://doi.org/10.1007/s12016-009-8192-4; PMid:20063186 PMCid:PMC2891868