Aktuelles zu Schwangerschaften bei entzündlich-rheumatischen Erkrankungen

Was ist neu?

Planung von Schwangerschaften Fragen der Familienplanung sind ein wichtiger Bestandteil in der Betreuung von Patientinnen mit entzündlich-rheumatischen Erkrankungen. Die Thematik sollte frühzeitig angesprochen werden. Eine sorgfältige Planung führt nachweislich zu mehr erfolgreichen und komplikationsarmen Schwangerschaften. Zunehmend in den Fokus rückt das Screening nach Risikofaktoren für eine Präeklampsie, da sich hieraus die Indikation zu einer prophylaktischen Einnahme von niedrig dosiertem Aspirin ab der Frühschwangerschaft ergeben kann. Neuere Empfehlungen unterstützen dabei praxisnah.

Schwangerschaftsverlauf Bei Frauen mit Rheumatoider Arthritis oder Spondyloarthritis, die mit biologischen krankheitsmodifizierenden antirheumatischen Medikamenten (bDMARDs) behandelt werden, sollte eine Fortsetzung der Medikamentengabe während der Schwangerschaft in Betracht gezogen werden, um das Risiko eines Krankheitsschubs und nachteiliger Schwangerschaftsfolgen zu reduzieren. Bei SLE-Schwangerschaften bietet eine HCQ-Therapie mit einer Reduktion des Risikos einer Präeklampsie und eines kongenitalen AV-Blocks einen Benefit, der über die reine Krankheitskontrolle hinausgeht.

Therapie vor, in und nach der Schwangerschaft Eine stabile Erkrankung unter schwangerschaftskompatibler Medikation stellt einen der wichtigsten prädiktiven Faktoren für einen guten Schwangerschaftsverlauf dar. Die Evidenz zur Sicherheit von antirheumatischen Therapien steigt stetig. Aktuelle Empfehlungen sollten in der Beratung beachtet werden.

Abstract

Women with rheumatic diseases should receive pre-pregnancy counselling to plan their pregnancy based on their individual risk profile. Low-dose aspirin is highly valued in the prevention of pre-eclampsia and is recommended for any lupus patient. In women with rheumatoid arthritis treated with bDMARDs, continuation during pregnancy should be considered to reduce the risk of disease relapse and adverse pregnancy outcomes. NSAIDs should be discontinued after the 20th week of pregnancy if possible. In SLE pregnancies, a lower glucocorticoid dose (6.5–10 mg/day) than previously thought is associated with preterm birth. HCQ therapy in pregnancy offers a benefit that clearly goes beyond mere disease control and should be emphasized accordingly in counselling. The use of HCQ is recommended for all SS-A-positive women from the 10th week of pregnancy at the latest, especially in the case of previous cAVB. Continuation of belimumab during pregnancy should be decided on an individual basis.

Stable disease under pregnancy-compatible medication is one of the most important predictive factors for a good pregnancy outcome. Current recommendations should be considered in individual counselling.

Schlüsselwörter

Rheumatoide Arthritis - Systemischer Lupus Erythematodes - Spondyloarthritis - Schwangerschaft - Therapie

Keywords

Rheumatoid Arthritis - Systemic Lupus Erythematosus - Spondyloarthritis - Pregnancy - Therapy

Publication History

Article published online:
06 March 2023

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