Since the beginning of life, female animals have been responsible for reproduction. Patients with SLE are no exception, and they have the same desire to bear children.
Systemic lupus erythematosus (SLE) is a disease directly related to fertility, with a prevalence of 110 per 100,000 in China. The peak age is 25 to 35 years old. So many patients are worried about their fertility problems.
Of course, SLE patients are at risk of pregnancy loss, with failure rates (miscarriage, stillbirth, etc.) as high as 10% to 35%. This is because SLE is closely related to hormone levels in the body. Pregnancy in turn worsens SLE, with a deterioration rate of 16.7% to 56.3%. The rate of deterioration is 16.7 ~ 56.3%. The time of deterioration is mostly in early pregnancy and early postpartum period, especially in patients with renal lesions, and the rate of deterioration is higher as pregnancy progresses. The rate of SLE deterioration after delivery is 7 times higher than that before pregnancy.
So, how to effectively improve the success rate of pregnancy and reduce the rate of loss?
First, the etiology of pregnancy loss in SLE patients must be properly understood. Second, choose the correct timing of pregnancy. Again, strengthen the management and monitoring of mother and child during pregnancy. Of course, hormonal and adjuvant medication should be used rationally to safely survive the entire pregnancy.
What are the causes of SLE pregnancy loss?
1. The disease is not fully controlled, i.e. the disease is still in the active stage of pregnancy.
2, the presence of coagulation dysfunction: SLE patients can be combined with antiphospholipid syndrome, the disease can appear thrombosis; the application of hormone therapy and will make the blood hypercoagulation.
3, placental factors.
4, combined with renal impairment.
5, previous history of miscarriage.
The above conditions may cause pregnancy failure.
How to control the timing of pregnancy in SLE patients?
It is currently advocated that pregnancy can be considered if the following conditions are met.
1.No significant organ involvement.
2, stable disease for at least six months and preferably more than one year.
3. Prednisone dosage is less than 10 mg per day and immunosuppressive drugs (such as cyclophosphamide, methotrexate, ralston, etc.) have been stopped for more than six months.
4, stable renal function (creatinine ≤ 140umol/L, creatinine clearance > 50ml/min); urine protein ≤ 3g/24h.
5, those who originally had positive antiphospholipid antibodies, it is best to wait for more than 3 months for negative antiphospholipid antibodies before pregnancy to reduce the occurrence of spontaneous abortion.
6, no serious side effects caused by hormones. And so on.
It is only when the above conditions are met that pregnancy can be considered, and only when pregnancy is carried out under the above conditions will there be a possibility of successful pregnancy.
Of course, in order to increase the success rate of pregnancy, hormone therapy should be applied consistently and immunosuppressive drugs should be added if necessary.
Adrenocorticotropic hormone is the most important drug in the treatment of SLE combined with pregnancy, and it is also the most important treatment to reduce the rate of pregnancy loss and control the disease activity. For those who have stopped prednisone before pregnancy, 5-10 mg/d can be given after pregnancy depending on the condition of SLE and can be continued as maintenance dose until delivery.
Low-dose aspirin (25-50 mg/d) is safe throughout pregnancy, and the combination of low-dose aspirin + low-molecular-weight heparin is used from early pregnancy in patients with APS-positive SLE and those with a history of adverse early pregnancy loss. SLE patients with a previous history of mid- to late-term miscarriage and stillbirth are recommended to start aspirin before pregnancy and add low-molecular-weight heparin subcutaneously once the pregnancy is successful. However, when using aspirin, platelet aggregation tests must be monitored at the same time and must be used with caution once it is ≤ 60% and must be discontinued when it is ≤ 45% or there is a clinically significant bleeding tendency.
Effective and appropriate treatment can increase the success rate of pregnancy by 19% to 70%.
High-dose hormone therapy is best avoided during pregnancy. If hormones alone do not control the disease well, immunosuppressive drugs may be added. The most suitable drug is azathioprine. Domestic and foreign studies have reported no adverse effects of azathioprine on fertility, and no teratogenicity has been found so far. A large number of pregnant women have been treated with azathioprine at Shanghai Renji Hospital with excellent results and no side effects on the fetus have been found. It is relatively safe (50mg/d) to take during pregnancy.
In addition, it has been found in recent years that continued use of hydroxychloroquine during pregnancy significantly reduces disease activity, while the rate of fetal loss is also significantly reduced and no teratogenicity has been reported.
Appropriately timed pregnancy is a prerequisite for a successful pregnancy, medication is a guarantee for a successful pregnancy, and pregnancy monitoring is a messenger to ensure a successful pregnancy. During pregnancy to be more diligent than healthy pregnant women project more.
1.B ultrasound examination: 1 time in 2 months in early and middle pregnancy, 1 time in 1 month in late pregnancy
2.Fetal ECG: 1 time every 2 weeks in late pregnancy
3.Fetal placental function measurement: 24-hour urine E3, once a week after 33 weeks of pregnancy
4.Fetal heart monitoring: 1-2 times per week from 34 weeks of gestation, and 2 times per week after 37 weeks of gestation.
Do amniocentesis if necessary.
To do all the above points carefully, I believe SLE patients will be able to give birth to a healthy and lively baby. May we protect all SLE patients for a successful pregnancy.