El embarazo en mujeres con lupus eritematoso sistémico: una revisión integrativa

Patricia Mesa-Abad; Lucía Tovar-Muñoz; Irene Serrano-Navarro; Pedro E. Ventura-Puertos; José Berlango-Jiménez

doi:10.37551/S2254-28842020002

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November 10, 2019

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March 30, 2020

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Abstract

Introduction: At present, it is known that systemic lupus erythematosus does not affect fertility; however, pregnancy in these women is associated with risks, both maternal and fetal. Objective: To determine the variables involved in the preparation and control of pregnancy in women with systemic lupus erythematosus, as well as the most important nursing actions. Material and Method: An integrative review has been carried out through a search in the ProQuest, PubMed and Web of Science databases. Original, observational and review scientific articles were included, in English and Spanish, excluding those articles published before 2009 or that were not in full text in the databases. Results: 15 articles published between 2009 and 2019 have been included. Pregnancy in patients with systemic lupus erythematosus is complex. Comprehensive and continuous control is required to achieve good results. A change of treatment, laboratory tests from time to time and the monitoring of a multidisciplinary team will control the disease and will reduce the risk of maternal and fetal complications. Conclusions: Currently, most women with systemic lupus erythematosus can achieve the goal of motherhood, if the disease is controlled at least 6 months before conception and throughout pregnancy. The most determinant variables in pregnancy of women with systemic lupus erythematosus are fertility, complications or treatment, which directly influence pregnancy

Keywords

systemic lupus erythematosus fertility pregnancy complications pregnancy control nursing interventions

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Mesa-Abad P, Tovar-Muñoz L, Serrano-Navarro I, Ventura-Puertos PE, Berlango-Jiménez J. Pregnancy in women with systemic lupus erythematosus: an integrative review. Enferm Nefrol [Internet]. 2020 [cited 2025 Apr 24];23(1):[about 11 p.]. Available from: https://enfermerianefrologica.com/revista/article/view/3827

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References

Gómez-Puerta JA, Cervera R. Lupus eritematoso sistémico. Medicina y Laboratorio. 2008;14:211-23.
Enríquez-Mejía MG. Fisiopatología del lupus eritematoso sistémico. Rev. med. investig. 2013;1(1):8-16.
Enciclopedia Médica A.D.A.M. [Internet]. Atlanta (GA): A.D.A.M., Inc.; 2005. Lupus eritematoso sistémico; 2018 ene [Consultado 9 abr 2019]. Disponible en: https://medlineplus.gov/spanish/ency/article/000435.htm.
Bãlãnescu A, Donisan T, Bãlãnescu D. An ever-challenging relationship: lupus and pregnancy. Reumatología. 2017;55(1):29-37. DOI: https://doi.org/10.5114/reum.2017.66685
Sánchez-Rodríguez SH, Barajas-Vásquez GE, Ramírez-Alvarado ED, Moreno-García A, Barbosa-Cisneros OY. Lupus eritematoso: enfermedad autoinmune sistémica y órgano específica. Rev Biomed. 2004;15:173-80. DOI: https://doi.org/10.32776/revbiomed.v15i3.388
Gcelu A. Rheumatic diseases and pregnancy. S Afr Med J. 2014;104(9):643. DOI: https://doi.org/10.7196/SAMJ.8763
Tower C, Crocker I, Chirico D, Baker P, Bruce I. SLE and pregnancy: the potential role for regulatory T cell. Nat. Rev. Rheumatol. 2011;7(2):124-8. DOI: https://doi.org/10.1038/nrrheum.2010.124
Soh MC, Nelson-Piercy C. High-risk pregnancy and the rheumatologist. Rheumatology (Oxford). 2015;54(4):572-87. DOI: https://doi.org/10.1093/rheumatology/keu394
Singh AG, Chowdhary VR. Pregnancy-related issues in women with systemic lupus erythematosus. Int J Rheum Dis. 2015;18(2):172-81. DOI: https://doi.org/10.1111/1756-185X.12524
Abarientos C, Sperber K, Shapiro DL, Aronow WS, Peng Chao C, Ash JY. Hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis and its safety in pregnancy. Expert Opin. Drug Saf. 2011;10(5):705-14. DOI: https://doi.org/10.1517/14740338.2011.566555
Sciascia S, Sciascia S, Hunt BJ, Talavera-García E, Lliso G, Khamashta MA, Cuadrado MJ. The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies. Am J Obstet Gynecol. 2016;214(2):273.e1-273.e8. DOI: https://doi.org/10.1016/j.ajog.2015.09.078
Ponticelli C, Moroni G. Immunosuppression in pregnant women with systemic lupus erythematosus. Expert Rev. Clin. Immunol. 2015;11(5):549-52. DOI: https://doi.org/10.1586/1744666X.2015.1033404
Chong Zhang, Mei-ying Liang, Xue Xu, Xue-wu Zhang, Shi Chen. Clinical features of new-onset systemic lupus erythematosus in pregnant patients. J. Obstet. Gynaecol. Res. 2017;44(2):234-40. DOI: https://doi.org/10.1111/jog.13520
Alonso MD, Llorca J, Martínez-Vázquez F, Miranda-Filloy JA, Diaz de Teran T, Dierssen T et al. Systemic Lupus Erythematosus in Northwestern Spain. A 20-Year Epidemiologic Study. Medicine 2011; 90(5):350-8. DOI: https://doi.org/10.1097/MD.0b013e31822edf7f
Andreoli L, Crisafulli F, Tincani A. Pregnancy and reproductive aspects of systemic lupus erythematosus. Curr Opin Rheumatol. 2017;29(5):473-9. DOI: https://doi.org/10.1097/BOR.0000000000000415
Moroni G, Ponticelli C. Pregnancy in women with systemic lupus erythematosus (SLE). Eur J Intern Med. 2016;32:7-12. DOI: https://doi.org/10.1016/j.ejim.2016.04.005
Barbhaiya M, Bermas BL. Evaluation and management of systemic lupus erythematosus and rheumatoid arthritis during pregnancy. Clin. Inmunol. 2013; 149(2):225-35. DOI: https://doi.org/10.1016/j.clim.2013.05.006
Lateef A, Petri M. Systemic Lupus Erythematosus and Pregnancy. Rheum. Dis. Clin. N. Am. 2017; 20(1):87-118. DOI: https://doi.org/10.1016/S0889-857X(21)00227-1
Eudy AM, Jayasundara M, Haroun T, Neil L, James AH, Clowse MEB. Reasons for cesarean and medically indicated deliveries in pregnancies in women with systemic lupus erythematosus. Lupus. 2017; 27(3):351-6. DOI: https://doi.org/10.1177/0961203317720525
Sammaritano LR. Management of Systemic Lupus Erythematosus During Pregnancy. Annu. Rev. Med. 2017;68:271-85. DOI: https://doi.org/10.1146/annurev-med-042915-102658
Bitencourt N, Bermas BL. Pharmacological Approach to Managing Childhood-Onset Systemic Lupus Erythematosus During Conception, Pregnancy and Breastfeeding. Adis. 2018;20(6):511-21. DOI: https://doi.org/10.1007/s40272-018-0312-2
Cooper WO, Cheetham TC, Li DK, Stein CM, Callahan ST, Morgan TM et al. Brief report: Risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune-mediated diseases in pregnancy. Arthritis Rheumatol. 2014;66(2):444-50. DOI: https://doi.org/10.1002/art.38262
Quinzanos I, Davis L, Keniston A, Nash A, Yazdany J, Fransen R et al. Application and feasibility of systemic lupus erythematosus reproductive health care quality indicators at a public urban rheumatology clinic. Lupus. 2014;24(2):203-9. DOI: https://doi.org/10.1177/0961203314552832
Rutan Kartoz C. Reproductive health concerns in women with Systemic lupus Erythematosus. MCN. Am J Matern Child Nurs. 2015;40(4):220-6. DOI: https://doi.org/10.1097/NMC.0000000000000145
Guibert Toledano ZM, Reyes Llerena GA, Rigñack Ramírez L, Cruz García Y, Acosta Lapera D, Salgado Galloso SB. Embarazo y puerperio en el lupus eritematoso sistémico. Actualización. Rev. cuba. reumatol. 2013;15(2):71-5.
Yang MJ, Chen CY, Chang WH, Tseng JY, Yeh CC. Pregnancy outcome of systemic lupus erythematosus in relation to lupus activity before and during pregnancy. J Chin Med Assoc.2014;78(4):235-40. DOI: https://doi.org/10.1016/j.jcma.2014.11.008
Rodríguez Almaraz ME, Rabadán Rubio E, Lozano F. Protocolo de manejo del lupus eritematoso sistémico en el embarazo. Medicine. 2017;12(25):1474-77. DOI: https://doi.org/10.1016/j.med.2017.01.007
Ugarte A, Villar I, Ruiz-Irastorza G. Manejo del embarazo en pacientes con lupus eritematoso sistémico. Rev Clin Esp. 2012;212(10):491-8. DOI: https://doi.org/10.1016/j.rce.2011.11.003
Jara LJ, Medina G, Cruz-Domínguez P, Navarro C, Vera-Lastra O, Saavedra MA. Risk factors of systemic lupus erythematosus flares during pregnancy. Inmunol Res. 2014;60(2-3):184-92. DOI: https://doi.org/10.1007/s12026-014-8577-1
Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal Sepsis Mortality and Morbidity During Hospitalization for Delivery: Temporal Trends and Independent Associations for Severe Sepsis. Anesth Analg. 2013;117(4):944-50. DOI: https://doi.org/10.1213/ANE.0b013e3182a009c3

References

Gómez-Puerta JA, Cervera R. Lupus eritematoso sistémico. Medicina y Laboratorio. 2008;14:211-23.

Enríquez-Mejía MG. Fisiopatología del lupus eritematoso sistémico. Rev. med. investig. 2013;1(1):8-16.

Enciclopedia Médica A.D.A.M. [Internet]. Atlanta (GA): A.D.A.M., Inc.; 2005. Lupus eritematoso sistémico; 2018 ene [Consultado 9 abr 2019]. Disponible en: https://medlineplus.gov/spanish/ency/article/000435.htm.

Bãlãnescu A, Donisan T, Bãlãnescu D. An ever-challenging relationship: lupus and pregnancy. Reumatología. 2017;55(1):29-37. DOI: https://doi.org/10.5114/reum.2017.66685

Sánchez-Rodríguez SH, Barajas-Vásquez GE, Ramírez-Alvarado ED, Moreno-García A, Barbosa-Cisneros OY. Lupus eritematoso: enfermedad autoinmune sistémica y órgano específica. Rev Biomed. 2004;15:173-80. DOI: https://doi.org/10.32776/revbiomed.v15i3.388

Gcelu A. Rheumatic diseases and pregnancy. S Afr Med J. 2014;104(9):643. DOI: https://doi.org/10.7196/SAMJ.8763

Tower C, Crocker I, Chirico D, Baker P, Bruce I. SLE and pregnancy: the potential role for regulatory T cell. Nat. Rev. Rheumatol. 2011;7(2):124-8. DOI: https://doi.org/10.1038/nrrheum.2010.124

Soh MC, Nelson-Piercy C. High-risk pregnancy and the rheumatologist. Rheumatology (Oxford). 2015;54(4):572-87. DOI: https://doi.org/10.1093/rheumatology/keu394

Singh AG, Chowdhary VR. Pregnancy-related issues in women with systemic lupus erythematosus. Int J Rheum Dis. 2015;18(2):172-81. DOI: https://doi.org/10.1111/1756-185X.12524

Abarientos C, Sperber K, Shapiro DL, Aronow WS, Peng Chao C, Ash JY. Hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis and its safety in pregnancy. Expert Opin. Drug Saf. 2011;10(5):705-14. DOI: https://doi.org/10.1517/14740338.2011.566555

Sciascia S, Sciascia S, Hunt BJ, Talavera-García E, Lliso G, Khamashta MA, Cuadrado MJ. The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies. Am J Obstet Gynecol. 2016;214(2):273.e1-273.e8. DOI: https://doi.org/10.1016/j.ajog.2015.09.078

Ponticelli C, Moroni G. Immunosuppression in pregnant women with systemic lupus erythematosus. Expert Rev. Clin. Immunol. 2015;11(5):549-52. DOI: https://doi.org/10.1586/1744666X.2015.1033404

Chong Zhang, Mei-ying Liang, Xue Xu, Xue-wu Zhang, Shi Chen. Clinical features of new-onset systemic lupus erythematosus in pregnant patients. J. Obstet. Gynaecol. Res. 2017;44(2):234-40. DOI: https://doi.org/10.1111/jog.13520

Alonso MD, Llorca J, Martínez-Vázquez F, Miranda-Filloy JA, Diaz de Teran T, Dierssen T et al. Systemic Lupus Erythematosus in Northwestern Spain. A 20-Year Epidemiologic Study. Medicine 2011; 90(5):350-8. DOI: https://doi.org/10.1097/MD.0b013e31822edf7f

Andreoli L, Crisafulli F, Tincani A. Pregnancy and reproductive aspects of systemic lupus erythematosus. Curr Opin Rheumatol. 2017;29(5):473-9. DOI: https://doi.org/10.1097/BOR.0000000000000415

Moroni G, Ponticelli C. Pregnancy in women with systemic lupus erythematosus (SLE). Eur J Intern Med. 2016;32:7-12. DOI: https://doi.org/10.1016/j.ejim.2016.04.005

Barbhaiya M, Bermas BL. Evaluation and management of systemic lupus erythematosus and rheumatoid arthritis during pregnancy. Clin. Inmunol. 2013; 149(2):225-35. DOI: https://doi.org/10.1016/j.clim.2013.05.006

Lateef A, Petri M. Systemic Lupus Erythematosus and Pregnancy. Rheum. Dis. Clin. N. Am. 2017; 20(1):87-118. DOI: https://doi.org/10.1016/S0889-857X(21)00227-1

Eudy AM, Jayasundara M, Haroun T, Neil L, James AH, Clowse MEB. Reasons for cesarean and medically indicated deliveries in pregnancies in women with systemic lupus erythematosus. Lupus. 2017; 27(3):351-6. DOI: https://doi.org/10.1177/0961203317720525

Sammaritano LR. Management of Systemic Lupus Erythematosus During Pregnancy. Annu. Rev. Med. 2017;68:271-85. DOI: https://doi.org/10.1146/annurev-med-042915-102658

Bitencourt N, Bermas BL. Pharmacological Approach to Managing Childhood-Onset Systemic Lupus Erythematosus During Conception, Pregnancy and Breastfeeding. Adis. 2018;20(6):511-21. DOI: https://doi.org/10.1007/s40272-018-0312-2

Cooper WO, Cheetham TC, Li DK, Stein CM, Callahan ST, Morgan TM et al. Brief report: Risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune-mediated diseases in pregnancy. Arthritis Rheumatol. 2014;66(2):444-50. DOI: https://doi.org/10.1002/art.38262

Quinzanos I, Davis L, Keniston A, Nash A, Yazdany J, Fransen R et al. Application and feasibility of systemic lupus erythematosus reproductive health care quality indicators at a public urban rheumatology clinic. Lupus. 2014;24(2):203-9. DOI: https://doi.org/10.1177/0961203314552832

Rutan Kartoz C. Reproductive health concerns in women with Systemic lupus Erythematosus. MCN. Am J Matern Child Nurs. 2015;40(4):220-6. DOI: https://doi.org/10.1097/NMC.0000000000000145

Guibert Toledano ZM, Reyes Llerena GA, Rigñack Ramírez L, Cruz García Y, Acosta Lapera D, Salgado Galloso SB. Embarazo y puerperio en el lupus eritematoso sistémico. Actualización. Rev. cuba. reumatol. 2013;15(2):71-5.

Yang MJ, Chen CY, Chang WH, Tseng JY, Yeh CC. Pregnancy outcome of systemic lupus erythematosus in relation to lupus activity before and during pregnancy. J Chin Med Assoc.2014;78(4):235-40. DOI: https://doi.org/10.1016/j.jcma.2014.11.008

Rodríguez Almaraz ME, Rabadán Rubio E, Lozano F. Protocolo de manejo del lupus eritematoso sistémico en el embarazo. Medicine. 2017;12(25):1474-77. DOI: https://doi.org/10.1016/j.med.2017.01.007

Ugarte A, Villar I, Ruiz-Irastorza G. Manejo del embarazo en pacientes con lupus eritematoso sistémico. Rev Clin Esp. 2012;212(10):491-8. DOI: https://doi.org/10.1016/j.rce.2011.11.003

Jara LJ, Medina G, Cruz-Domínguez P, Navarro C, Vera-Lastra O, Saavedra MA. Risk factors of systemic lupus erythematosus flares during pregnancy. Inmunol Res. 2014;60(2-3):184-92. DOI: https://doi.org/10.1007/s12026-014-8577-1

Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal Sepsis Mortality and Morbidity During Hospitalization for Delivery: Temporal Trends and Independent Associations for Severe Sepsis. Anesth Analg. 2013;117(4):944-50. DOI: https://doi.org/10.1213/ANE.0b013e3182a009c3