OriginalGuías de práctica clínica para la atención del embarazo en mujeres con enfermedades reumáticas autoinmunes del Colegio Mexicano de Reumatología. Parte IIClinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part II
Section snippets
Artritis reumatoide
La artritis reumatoide (AR) es una enfermedad inflamatoria sistémica caracterizada fudamentalmente por inflamación y proliferación destructiva de la membrana sinovial de origen autoinmune. La frecuencia de la AR se incrementa con la edad, pero tiende a afectar a mujeres desde su etapa reproductiva.
Síndrome por anticuerpos antifosfolípidos
El síndrome por anticuerpos antifosfolípidos (SAF) es una enfermedad autoinmune sistémica que se caracteriza por la presencia de anticuerpos antifosfolípidos y manifestaciones clínicas asociadas tales como trombosis arterial, trombosis venosa y/o complicaciones obstétricas, especialmente pérdidas recurrentes de la gestación30.
Fármacos antirreumáticos
Planear el embarazo en una mujer con enfermedad reumática requiere de un análisis cuidadoso de los fármacos con el objeto de mantener controlada la enfermedad y minimizar los riesgos fetales. La información del uso de los fármacos durante el embarazo es limitada y deriva en gran medida de la exposición inadvertida de los mismos durante embarazos no planeados (tabla 1).
Comentario final
La presente guía de práctica clínica puede ser fácil de difundir e implementar pero puede ser difícil de aplicar por diversas razones en el contexto de nuestro entorno sociocultural. Las pacientes tienen poca cultura acerca del impacto del embarazo en enfermedades reumáticas autoinmunes y en algunos sectores existe un acceso incompleto a los servicios de salud. Por otro lado, el conocimiento limitado de médicos no reumatólogos del efecto del embarazo sobre la enfermedad autoinmune y viceversa
Protección de personas y animales
Los autores declaran que para esta investigación no se han realizado experimentos en seres humanos ni en animales.
Confidencialidad de los datos
Los autores declaran que en este artículo no aparecen datos de pacientes.
Derecho a la privacidad y consentimiento informado
Los autores declaran que en este artículo no aparecen datos de pacientes.
Conflicto de intereses
El Colegio Mexicano de Reumatología recibió un apoyo educacional irrestricto de la empresa UCB. El personal que labora en UCB no tuvo ninguna injerencia con la información vertida en este manuscrito ni participó en las reuniones del grupo de trabajo.
Bibliografía (99)
- et al.
Rheumatoid arthritis and reproduction
Rheum Dis Clin N Am.
(2007) Managing contraception and pregnancy in the rheumatologic diseases
Best Practice Res Clin Rheumatol.
(2010)- et al.
Safety of contraceptive methods for women with rheumatoid arthritis: a systematic review
Contraception.
(2010) - et al.
Pregnancy and rheumatoid arthritis
Rheum Dis Clin North Am.
(1997) - et al.
Evaluation and management of systemic lupus erythematosus and rheumatoid arthritis during pregnancy
Clin Immunol.
(2013) Management of difficult clinical situations in patients with rheumatoid arthritis: Pregnancy
Reumatol Clin.
(2009)- et al.
Consenso SER sobre la gestión de riesgo del tratamiento con terapias biológicas en pacientes con enfermedades reumáticas
Reumatol Clin.
(2011) - et al.
International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)
J Thromb Haemost
(2006) - et al.
Antiphospholipid syndrome in pregnancy
Rheum Dis Clin North Am.
(2007) - et al.
Management of antiphospholipid syndrome
J Autoimmun.
(2009)
Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin treatment
Am J Obstet Gynecol.
First-trimester low-dose prednisolone in refractory antiphospholipid antibody-related pregnancy loss
Blood.
Low-molecular-weight heparin versus intravenous immunoglobulin for recurrent abortion associated with antiphospholipid antibody syndrome
Int J Gynaecol Obstet.
Anticoagulation in management of antiphospholipid antibody syndrome in pregnancy
Clin Lab Med.
The association between antiphospholipid antibodies and placenta mediated complications: a systematic review and meta-analysis
Thromb Res.
Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis
Am J Obstet Gynecol.
Multiple courses of antenatal corticosteroids for preterm birth (MAC): a randomised controlled trial
Lancet.
Antirheumatic drugs in pregnancy and lactation
Semin Arthritis Rheum.
Pregnancy outcome with inflammatory bowel disease following exposure to 5-aminosalicylic acid drugs: a meta-analysis
Reproductive Toxicol.
Tetrada of the possible mycophenolate mofetil embryopathy: a review
Reproductive Toxicol.
Pregnancy outcome following gestational exposure to TNF-alpha-inhibitors: a prospective, comparative, observational study
Reprod Toxicol.
How safe are anti-rheumatic drugs during pregnancy
Curr Opin Pharmacol.
Pregnancy outcomes after maternal exposure to rituximab
Blood.
Placental transfer of anti-tumor necrosis factor agents in pregnant patients with inflammatory bowel disease
Clin Gastroenterol Hepatol
Long-term follow-up of babies exposed to azathioprine in utero and via breastfeeding
J Crohns Colitis.
Fármacos durante el embarazo y métodos contraceptivos en enfermedades reumáticas. Nuevas aportaciones
Reumatol Clin.
Desenlace obstétrico antes y después del inicio de la artritis reumatoide
Rev Med Inst Mex Seguro Soc.
Disease activity of rheumatoid arthritis during pregnancy: Results from a Nationwide Prospective Study
Arthritis Care Res.
Does rheumatoid arthritis remit during pregnancy and relapse postpartum. Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy
Arthritis Rheum.
Benefit of pregnancy in inflammatory arthritis
Ann Rheum Dis.
Cytokines and pregnancy in rheumatic diseases
Ann NY Acad Sci.
Th1/Th2 cytokine profile in pregnant rheumatoid arthritis patients
Clin Exp Immunol.
Inducing tolerance to pregnancy
N Engl J Med.
Transfer of shared epitope through microchimerism in women with rheumatoid arthritis
Arthritis Rheum.
Measuring disease activity and functionality during pregnancy in patients with rheumatoid arthritis
Arthritis Care Res.
Women with rheumatoid arthritis negative for anti-cyclic citrullinated peptide and rheumatoid factor are more likely to improve during pregnancy, whereas in autoantibody-positive women autoantibody levels are not influenced by pregnancy
Ann Rheum Dis.
Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: a nationwide population-based study
Ann Rheum Dis.
Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight
Arthritis Rheum.
Rheumatoid arthritis and birth outcomes: a danish and swedish nation wide prevalence study
J Intern Med.
Systematic review on the safety of methotrexate in rheumatoid arthritis regarding the reproductive system (fertility, pregnancy, and breastfeeding)
Clin Exp Rheumatol.
The use of disease modifying antirheumatic drugs in women with rheumatoid arthritis of childbearing age: a survey of practice patterns and pregnancy outcomes
J Rheumatol.
Hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis and its safety in pregnancy
Expert Opin Drug Saf.
Canadian Rheumatology Association recommendations for pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs
J Rheumatol.
Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs
Rheumatology (Oxford).
Biologic therapy and pregnancy outcomes in women with rheumatic diseases
Arthritis Rheum.
A safety assessment of tumor necrosis factor antagonists during pregnancy: a review of the Food and Drug Administration database
J Rheumatol.
Breast-feeding and postpartum relapse in women with rheumatoid and inflammatory arthritis
Arthritis Rheum.
Combined oral contraceptives in women with systemic lupus erythematosus
N Engl J Med.
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2016, Clinics in DermatologyCitation Excerpt :It is imperative to restart contraception because lactation is not effective at preventing pregnancy. There is also an increased risk of venous thromboembolic disease in the 6 months after delivery, particularly in those with antiphospholipid antibody syndrome.72,85 All women should have their risk for venous thromboembolism assessed and receive postpartum thromboprophylaxis accordingly.85,100