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首页> 外文期刊>Pediatric drugs >Pharmacological Approach to Managing Childhood-Onset Systemic Lupus Erythematosus During Conception, Pregnancy and Breastfeeding
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Pharmacological Approach to Managing Childhood-Onset Systemic Lupus Erythematosus During Conception, Pregnancy and Breastfeeding

机译：在概念，怀孕和母乳喂养期间管理童年发病系统狼疮红斑狼疮的药理方法

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Pediatric patients often have poor pregnancy outcomes. Systemic lupus erythematosus predominantly impacts women in their second to fourth decade of life, with childhood-onset disease being particularly aggressive. Reproductive issues are an important clinical consideration for pediatric patients with systemic lupus erythematosus (SLE), as maintaining good disease control and planning a pregnancy are important for maternal and fetal outcomes. In this clinical review, we will consider the safety of medications in managing childhood-onset SLE during conception, pregnancy, and breastfeeding. The developing fetus is at highest risk for teratogenicity from maternal medications during the period of critical organogenesis, which occurs between the first 3-8weeks following conception. Medications known to be teratogenic, leading to a specific pattern of malformations, include mycophenolic acid, methotrexate, and cyclophosphamide. These should be discontinued prior to a planned pregnancy or as soon as pregnancy is suspected. Hydroxychloroquine is safe and should be continued throughout pregnancy and breastfeeding in those without contraindications to it. Azathioprine and calcineurin inhibitors are felt to be compatible with pregnancy in usual doses and may be used prior to and throughout pregnancy and lactation. Non-fluorinated corticosteroids including methylprednisolone and prednisone are inactivated by the placenta and can be used if needed for maternal indication during gestation. Addition of aspirin may be considered around the 12th week of gestation for prevention of pre-eclampsia. Illustrative cases are presented that demonstrate management of adolescents with childhood-onset SLE through conception, pregnancy, and breastfeeding.
机译：儿科患者常有妊娠结果差。 Systemic Lupus红斑地区主要影响妇女在其第二次到第四十年的生命中，童年发病疾病特别激进。生殖问题是患有全身狼疮红斑狼疮（SLE）的儿科患者的重要临床审查，因为保持良好的疾病控制和计划怀孕对孕产妇和胎儿结果很重要。在这一临床审查中，我们将考虑在概念，怀孕和母乳喂养期间管理童年发病SLE中的药物的安全性。发育中的胎儿在临界器官期间的孕产妇药物的致畸性的风险最高，这在概念后的前3-8周之间发生。已知致畸的药物，导致特定的畸形模式，包括氨基氯酸，甲氨蝶呤和环磷酰胺。这些应该在计划怀孕之前停止，或者在怀孕怀孕之前停止。羟基氯喹是安全的，在整个妊娠和母乳喂养中应继续持续到它的母乳喂养。含氮素和钙素蛋白抑制剂含有常用剂量的妊娠与妊娠相容，并且可以在妊娠和哺乳期之前使用。包括甲基己酮和泼尼松在内的非氟化皮质类固醇通过胎盘灭活，并且如果需要在妊娠期间母体指示使用。在妊娠前的第12周围绕预防预防预痫前一周，可以考虑阿司匹林。提出了通过概念，怀孕和母乳喂养的儿童发病SLE的青少年管理的说明性案例。

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  • 来源
    《Pediatric drugs》 |2018年第6期|共11页
  • 作者

    Bitencourt Nicole; Bermas Bonnie L.;

  • 作者单位

    Univ Texas Southwestern Med Ctr Dallas Div Rheumat Dis 5323 Harry Hines Blvd Dallas TX 75390 USA;

    Univ Texas Southwestern Med Ctr Dallas Div Rheumat Dis 5323 Harry Hines Blvd Dallas TX 75390 USA;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 药学;
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