Skip to main content
Log in

Rheumatische Erkrankungen in der Schwangerschaft

Rheumatic diseases during pregnancy

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die Behandlungsmöglichkeiten entzündlich-rheumatischer Erkrankungen wie der rheumatoiden Arthritis, Spondylitis ankylosans und des systemischen Lupus erythematodes verbessern sich stetig. Dies führt auch dazu, dass sich eine wachsende Zahl der oft jungen Patientinnen ihren Kinderwunsch erfüllen möchte. Das zunehmende Verständnis der Erkrankungsverläufe in der Schwangerschaft bzw. postpartal erlaubt eine optimierte Beratung der betroffenen Frauen vor Konzeption. Von entscheidender Bedeutung sind die Planung einer Schwangerschaft in einer möglichst inaktiven Erkrankungsphase und eine regelmäßige Überwachung. Dabei sind die sorgfältige Einschätzung möglicher Risiken und die Aufklärung über den Einsatz von antirheumatischen Therapien vor, während und nach einer Gravidität wichtige Bestandteile.

Abstract

The treatment of inflammatory rheumatic diseases, such as rheumatoid arthritis, spondylitis ankylosans and systemic lupus erythematosus, is improving continuously. This has lead to an increasing number of young patients with a wish to have children. Greater insight into the course of rheumatic diseases during pregnancy and post partum has enabled optimized support for women with rheumatic diseases wishing to have children. To ensure a favorable outcome, pregnancy should be started during a period of disease stability and should be monitored closely. A careful assessment of possible risks and the justified use of antirheumatic drugs before, during and after pregnancy are key issues for success.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Literatur

  1. Clowse ME, Chakravarty E, Costenbader KH et al (2011) 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) 64:668–674

    Google Scholar 

  2. Jawaheer D, Zhu JL, Nohr EA, Olsen J (2011) Time to pregnancy among women with rheumatoid arthritis. Arthritis Rheum 63:1517–1521

    Article  PubMed  Google Scholar 

  3. Wallenius M, Skomsvoll JF, Irgens LM et al (2010) Postpartum onset of rheumatoid arthritis and other chronic arthritides: results from a patient register linked to a medical birth registry. Ann Rheum Dis 69:332–336

    Article  PubMed  CAS  Google Scholar 

  4. Man YA de, Dolhain RJ, Geijn FE van de et al (2008) Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Rheum 59:1241–1248

    Article  PubMed  Google Scholar 

  5. Man YA de, Hazes JM, Heide H et al (2009) Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum 60:3196–3206

    Article  PubMed  Google Scholar 

  6. Chakravarty EF, Nelson L, Krishnan E (2006) Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum 54:899–907

    Article  PubMed  Google Scholar 

  7. Ostensen M, Ostensen H (1998) Ankylosing spondylitis – the female aspect. J Rheumatol 25:120–124

    Google Scholar 

  8. Lui NL, Haroon N, Carty A et al (2011) Effect of pregnancy on ankylosing spondylitis: a case-control study. J Rheumatol 38:2442–2444

    Google Scholar 

  9. Ostensen M, Fuhrer L, Mathieu R et al (2004) A prospective study of pregnant patients with rheumatoid arthritis and ankylosing spondylitis using validated clinical instruments. Ann Rheum Dis 63:1212–1217

    Article  PubMed  CAS  Google Scholar 

  10. Clowse ME (2007) Lupus activity in pregnancy. Rheum Dis Clin North Am 33:237–252

    Article  PubMed  Google Scholar 

  11. Clowse ME, Magder L, Witter F, Petri M (2006) Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 54:3640–3647

    Article  PubMed  Google Scholar 

  12. Clark CA, Spitzer KA, Laskin CA (2005) Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40-year period. J Rheumatol 32:1709–1712

    Google Scholar 

  13. Petri M, Howard D, Repke J (1991) Frequency of lupus flare in pregnancy. The Hopkins Lupus Pregnancy Center experience. Arthritis Rheum 34:1538–1545

    Article  PubMed  CAS  Google Scholar 

  14. Clowse ME, Magder LS, Witter F et al (2005) The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum 52:514–521

    Article  PubMed  Google Scholar 

  15. Chakravarty EF, Colón I, Langen ES et al (2005) Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol 192:1897–1904

    Article  PubMed  Google Scholar 

  16. Clowse ME, Jamison M, Myers E et al (2008) A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 199:127.e1–6

    Article  PubMed  Google Scholar 

  17. Chakravarty EF, Nelson L, Krishnan E (2006) Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum 54:899–907

    Article  PubMed  Google Scholar 

  18. Smyth A, Oliveira GH, Lahr BD et al (2010) A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 5:2060–2068

    Article  PubMed  Google Scholar 

  19. Day CJ, Lipkin GW, Savage CO (2009) Lupus nephritis and pregnancy in the 21st century. Nephrol Dial Transplant 24:344–347

    Article  PubMed  Google Scholar 

  20. Askie LM, Duley L, Henderson-Smart DJ et al (2007) Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 369:1791–1798

    Article  PubMed  CAS  Google Scholar 

  21. Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA (2010) Antiphospholipid syndrome. Lancet 376:1498–1509

    Article  PubMed  CAS  Google Scholar 

  22. Ruffatti A, Tonello M, Visentin MS et al (2011) Risk factors for pregnancy failure in patients with anti-phospholipid syndrome treated with conventional therapies: a multicentre, case-control study. Rheumatology (Oxford) 50:1684–1689

    Google Scholar 

  23. Bramham K, Hunt BJ, Germain S et al (2010) Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome. Lupus 19:58–64

    Article  PubMed  CAS  Google Scholar 

  24. Danza A, Ruiz-Irastorza G, Khamashta M (2012) Antiphospholipid syndrome in obstetrics. Best Pract Res Clin Obstet Gynaecol 26:65–76

    Article  PubMed  Google Scholar 

  25. Izmirly PM, Rivera TL, Buyon JP (2007) Neonatal lupus syndromes. Rheum Dis Clin North Am 33:267–285

    Article  PubMed  Google Scholar 

  26. Izmirly PM, Saxena A, Kim MY et al (2011) Maternal and fetal factors associated with mortality and morbidity in a multi-racial/ethnic registry of anti-SSA/Ro-associated cardiac neonatal lupus. Circulation 124:1927–1935

    Article  PubMed  Google Scholar 

  27. Izmirly PM, Kim MY, Llanos C et al (2010) Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine. Ann Rheum Dis 69:1827–1830

    Article  PubMed  CAS  Google Scholar 

  28. Fischer-Betz R, Gromnica-Ihle E (2010) Pregnancy and inflammatory rheumatic diseases. Z Rheumatol 69:633–641

    Google Scholar 

  29. Fischer-Betz RE, Schneider M (2010) Biologics during pregnancy and breast-feeding. Z Rheumatol 69:780–787

    Google Scholar 

Download references

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Fischer-Betz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fischer-Betz, R. Rheumatische Erkrankungen in der Schwangerschaft. Internist 53, 1047–1053 (2012). https://doi.org/10.1007/s00108-012-3029-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-012-3029-2

Schlüsselwörter

Keywords

Navigation