SLE und Schwangerschaft: Eigene Erfahrungen und Literaturübersicht der vergangenen 15 Jahre

The systemic lupus erythematosus affects mainly women in childbearing age. In earlier years, a pregnancy in these patients was generally not recommended, because the risk of a flare was considered to be too high. Evaluating 17 relevant studies published between 1980 and 1995 an overall risk for exacerbation of 37,31% was calculated. Patients with active disease at the time of conception flare more often than patients in remission. The incidence of spontaneus abortions, miscarriages, premature deliveries, intrauterine growth retardation and cesarean sections has been reported to be increased in SLE patients as compared to the normal population. In a cohort of 22 women with 26 pregnancies seen in our outpatient department a fetal wastage rate of 11,5%, 42,3% premature deliveries, one intrauterine growth retardation, 23% cases of preeclampsia and 38,5% cesarean sections were observed compared to a spontaneous abortion rate of 15 - 17%, 6 - 8% premature deliveries, 5 - 7% cases of preeclampsia and 12 - 25% cesarean sections in the normal population. Flares as judged by clinical and serological parameters occured in 11,5% of our patients. For monitoring disease activity the determination of complement factors, anti-dsDNA-antibodies and urinary sediment were helpful. Pregnant SLE-patients were treated with steroids and in the presence of anti-phospholipid-antibodies with low dose aspirin. Uncomplicated pregnancy courses were also reported from patients treated with azathioprine, cyclosporine or antimalarial drugs. From our experience we conclude that in general SLE-patients should no longer be advised against a pregnancy. Under adequate therapy and careful monitoring a successful outcome of pregnancy can usually be achieved.