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                    醫學地帶資訊編譯:妊娠期暴露于TNFi的母親和胎兒結局

                    目的:越來越多風濕病患者在妊娠期使用腫瘤壞死因子抑制劑(TNFi),但TNFi通常在妊娠中晚期予以停用。這項研究我們評估了與妊娠期停用TNFi的女性相比,整個妊娠期繼續使用TNFi女性的母親和胎兒結局。

                     

                    方法:我們回顧性分析了妊娠期暴露于TNFi的類風濕性關節炎(RA)、銀屑病關節炎、幼年特發性關節炎(JIA)或強直性脊柱炎患者的結局。我們根據TNFi暴露水平和比較的結局將妊娠分為2組。

                     

                    結果:在第1組患者(僅在孕早期暴露于TNFi)中,11名女性有14次妊娠和12名活產嬰兒。2次妊娠在孕早期流產(2/14,14%),其中1個是處于活動性RA時期。5次妊娠(5/14,35.7%)因疾病急性發作而復雜化。8名患者(8/12,66%)產后病情急性發作。在第2組患者(整個孕期均暴露于TNFi)中,29名女性有32次妊娠和34名活產嬰兒。2名患者有3個(3/28,10.7%)不良妊娠結局。1名患者為雙胎妊娠,并在32周JIA急性發作后胎膜早破在第33周早產。這名患者的第二次妊娠在妊娠前和妊娠期間因活動性JIA和溶血、肝酶升高以及第39周時低血小板水平(HELLP)綜合征而復雜化。另一名合并抗磷脂綜合征的患者因懷疑HELLP綜合征而在36周時進行剖腹產。有6次(6/32,18.7%)產后病情急性發作。

                     

                    結論:與妊娠期持續TNFi治療的患者相比,妊娠期TNFi停藥的女性圍產期或產后急性發作的風險更高。

                     

                    2017.10.12.1

                     

                    資訊原文及出處

                    Abstract

                     

                    Objective: Tumornecrosis factor inhibitors (TNFi) are increasingly used in pregnancy but arefrequently withheld in the second or third trimesters. We evaluated thematernal and fetal outcomes of women who continued their TNFi throughoutpregnancy compared to women who interrupted TNFi during pregnancy.

                     

                    Methods: Weretrospectively analyzed the outcomes of women seen in clinic with rheumatoidarthritis (RA), psoriatic arthritis, juvenile idiopathic arthritis (JIA), orankylosing spondylitis, who were exposed to TNFi during pregnancy. We separatedpregnancies into 2 groups based on the level of TNFi exposure and comparedoutcomes.

                     

                    Results InGroup 1 (TNFi exposure in first trimester only), 11 women had 14 pregnanciesand 12 live births. There were 2 first-trimester losses (2/14, 14%), one in thesetting of active RA. Five pregnancies (5/14, 35.7%) were complicated by adisease flare. Eight patients (8/12, 66%) flared postpartum. In Group 2 (TNFiexposure throughout pregnancy), 29 women had 32 pregnancies and 34 live births.Three (3/28, 10.7%) adverse pregnancy outcomes were reported in 2 patients. Onepatient had a twin pregnancy and delivered at 33 weeks after developing pretermpremature rupture of membranes at 32 weeks in the setting of a JIA flare. Hersecond pregnancy was complicated by active JIA before and throughout gestation,and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP)syndrome at 39 weeks. Another patient with comorbid antiphospholipid syndromeunderwent a cesarean birth at 36 weeks for suspicion of HELLP syndrome. Six(6/32, 18.7%) postpartum flares occurred.

                     

                    Conclusion Womenwho discontinued their TNFi during pregnancy had a higher risk of peri- orpostpartum flare compared to those who continued their TNFi throughoutpregnancy.

                     

                    Geneviève G, et al. Maternal and FetalOutcomes in a Cohort of Patients Exposed to Tumor Necrosis Factor Inhibitorsthroughout Pregnancy. J Rheumatol. 03 July 2018.

                     

                     

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