When systemic lupus encounter pregnancy, how to deal with the mother and child to ensure the safety of the mother and child?

The publication of authoritative guidelines such as "recommendations on perinatal management of systemic lupus erythematosus patients in China" and "2020 guidelines for diagnosis and treatment of systemic lupus erythematosus" provide scientific guidance for pregnancy management of SLE patients.systemic lupus erythematosus (SLE) is a systemic autoimmune disease, which is more common in women. The ratio of male to female is 1:10 ~ 12.with the progress of diagnosis and treatment, the survival rate of SLE patients has been greatly improved.at present, the 20-year survival rate of SLE patients is more than 60%, which also means that SLE has changed from acute fatal disease to chronic controllable disease. Besides "reducing mortality", the treatment goal of disease should also include "improving the quality of life of patients" to meet the needs of patients at a higher level.in this context, the reproductive requirements of female SLE patients of childbearing age are more and more prominent.especially after the adjustment of family planning policy, the management of SLE patients during pregnancy has become the focus and difficulty of clinical attention.the medical community had a dialogue with Professor Zeng Xiaofeng, President of Rheumatology and Immunology branch of Chinese Medical Doctor Association and Beijing Union Medical College Hospital, and asked him to share his experience and views on the management of SLE patients during pregnancy.pregnancy management of SLE patients is the focus and difficulty of treatment. Women of childbearing age are the main population of SLE, and the fertility of female SLE patients has no difference compared with non SLE women of the same age.Professor Zeng Xiaofeng pointed out that with the development of science and technology and the improvement of neonatal monitoring level, especially the deep understanding of SLE, SLE is no longer the absolute contraindication of pregnancy.however, due to the role of sex hormones in the pathogenesis of SLE, more than half of SLE patients will relapse or worsen during pregnancy, endangering the safety of pregnant women and fetus.according to statistics, the maternal and infant mortality rate of pregnant women with SLE in China is as high as 8.9% [1]. Therefore, standardizing the perinatal management of SLE patients is the focus and difficulty of the treatment of female SLE patients of childbearing age.in April 2015, led by the China systemic lupus erythematosus research collaboration group, on the basis of referring to relevant international research data and management recommendations, combined with the actual situation in China, formulated the "management recommendations for the perinatal period of systemic lupus erythematosus patients in China" (hereinafter referred to as "management suggestions") [1] in order to strengthen the pregnancy management of SLE patients and improve the pregnancy success of SLE patients in China And the survival rate of mother and infant.in October of the same year, China fully opened the two child policy, and the reproductive needs of female SLE patients of childbearing age were further improved.in the latest edition of "2020 guidelines for diagnosis and treatment of systemic lupus erythematosus (hereinafter referred to as" the new guidelines "), the expert group also paid special attention to the management of SLE pregnancy, recommended the timing of pregnancy, multidisciplinary cooperation, close follow-up of mothers and infants, and the use of drugs for disease control. It was pointed out that hydroxychloroquine, oral glucocorticoids, azathioprine, cyclosporin and tacrolimus can be used in the prevention and treatment of SLE To prevent or control the onset of SLE during pregnancy.Professor Zeng Xiaofeng believes that these suggestions, combined with the "recommendations on perinatal management of systemic lupus erythematosus in China", can promote the communication between rheumatologists, obstetricians and pediatricians and pregnant women with SLE, so as to jointly face the risks during pregnancy.standardizing the pregnancy management of SLE patients is the key to improve the survival rate."SLE patients must meet the following conditions at the same time before they can consider pregnancy: a. the condition is inactive and stable for at least 6 months; B. the dosage of glucocorticoid is less than 15 mg / D (or equivalent dose); C. 24-hour urinary protein excretion is less than 0.5g; D. there is no important organ damage; e. immunosuppressive drugs such as cyclophosphamide, methotrexate, Tripterygium wilfordii, mold should be stopped For patients taking leflunomide, it is recommended to take drug clearance treatment first, and then stop the drug for at least 6 months before considering pregnancy. contraindications for pregnancy in SLE patients include: A. severe pulmonary hypertension (estimated pulmonary systolic pressure > 50mmhg, or clinical symptoms of pulmonary hypertension); B. severe restrictive pulmonary disease [forced vital capacity (FVC) < 1 l]; C. heart failure; D. chronic renal failure [serum creatinine (SCR) > 2.8mg / l]; e. previous severe preeclampsia or even after treatment with aspirin HELLP syndrome, which is still uncontrollable with aspirin and heparin therapy; F. stroke in the past 6 months; g. severe lupus disease activity in the past 6 months. it is very important to monitor the disease activity and fetal growth and development of SLE patients during pregnancy. after determining the pregnancy, the follow-up frequency during the whole pregnancy should be considered according to the specific situation of the patient. it is recommended to follow up every 4 weeks before 28 weeks of pregnancy, and once every 2 weeks from the 28th week. however, since the patient's condition changes rapidly after 28 weeks of pregnancy, the follow-up interval should be determined by the obstetrician according to the specific situation. for patients with stable condition during the whole pregnancy process, natural delivery can be adopted to end pregnancy, but for patients with unstable condition or obstetric complications during pregnancy, cesarean section can be adopted. research data show that nearly 50% of SLE patients will have disease activity or recurrence during pregnancy. Considering the particularity of medication during pregnancy, the treatment of relapse of SLE patients during pregnancy is a difficult problem that cannot be ignored in the management process of SLE pregnancy. according to the management suggestions, the drugs available for SLE patients during pregnancy include glucocorticoids, some immunosuppressants, hydroxychloroquine, NSAIDs, paracetamol and antihypertensive drugs. hydroxychloroquine is a safe drug confirmed by clinical experience. For patients with positive antiphospholipid antibody, hydroxychloroquine should be used after pregnancy to reduce the risk of thrombosis. For SLE patients with positive anti SSA or anti SSB, it is recommended to take it to reduce the incidence of fetal heart block. The recommended dose is 200mg, twice a day. the new guidelines also emphasize that hydroxychloroquine can reduce the preterm birth rate of SLE pregnant women, reduce the recurrence of lupus erythematosus, and reduce the risk of adverse fetal outcomes. Continuous hydroxychloroquine treatment can reduce the recurrence of SLE during pregnancy and postpartum. If there is no taboo, it is recommended to use it continuously throughout pregnancy. for patients with active diseases during pregnancy, hormone, hydroxychloroquine and immunosuppressants available during pregnancy can be considered to control the disease. conclusion: the pregnancy process of SLE patients is a pathological process. The interaction between pregnancy process and disease will cause disease recurrence and aggravation, lead to pregnancy failure and fetal loss, and endanger the life of pregnant women. Standardized management and strict detection are the key to reduce the risk of adverse pregnancy and maternal death. the publication of authoritative guidelines such as "recommendations on perinatal management of systemic lupus erythematosus patients in China" and "2020 guidelines for diagnosis and treatment of systemic lupus erythematosus" provide scientific guidance for pregnancy management of SLE patients. Professor Zeng Xiaofeng believes that the pregnancy management of SLE patients should be completed by a multidisciplinary team including rheumatology and Immunology experts and obstetricians and gynecology doctors. he pointed out that after more than 30 years of difficult development in rheumatology and immunology in China, the guidelines for the construction and management of Rheumatology and Immunology Department of general hospitals issued by the national health and Health Commission, the establishment of the National Clinical Research Center for skin and immune diseases, and the access of several rheumatic immune drugs in the national medical insurance catalogue, all indicate that the discipline has entered the Yellow River Golden opportunity. this requires us to take the responsibility together, and more interdisciplinary experts are needed to pay attention to SLE, further carry out clinical problem-oriented related research, and solve the key and difficult problems of clinical concern. Prof. Zeng Xiaofeng, director of Rheumatology and Immunology Department, Peking Union Medical College Hospital, director of national clinical research center of Dermatology and immune diseases, vice chairman of aplar, executive director of Chinese Medical Association and chairman of Rheumatology and Immunology branch of Chinese Medical Association, 9th and 10th chairman of Rheumatology branch of Chinese Medical Association Deputy chairman of the clinical immunology branch of the Chinese society of rehabilitation medicine bone and joint and rheumatism branch, standing director of the cross strait Medical Exchange Association, standing director of the Beijing Medical Association, honorary chairman of the rheumatism professional committee, and head of the China systemic lupus erythematosus research collaboration group (CStar) and national rheumatology data center (CRDC). EUSTAR（EULAR Scleroderma Trials and Research, EUSTAR) chairman of the 18th aplar conference, member of the Scientific Committee of the 10th European lupus Congress, member of the Advisory Committee of the 10th International Conference on autoimmune diseases, deputy editor in chief of the National Textbook internal medicine, chief editor of Rheumatology internal medicine, national standard textbook for postgraduates, and rheumatic immunology Editor in chief of standardized training textbook for disease residents, deputy editor in chief of Chinese Journal of clinical immunology and allergy, deputy editor in chief of Chinese Journal of Rheumatology, deputy editor in chief of Chinese Journal of internal medicine deputy editor in chief of Chinese Journal of Practical Internal Medicine In September 2017, the winner of the award for outstanding achievements of famous doctors of people's network of China won the title of China's original research of changing practice in 2018: the winner of the title of top 10 original research leaders witness the development of 70 years in 2019, pay tribute to the monument of the medical community: the live announcement of the top ten original medical breakthrough awards "2020 Chinese systemic lupus erythematosus diagnosis and treatment guidelines" was published by the Chinese Medical Association In this paper, 12 clinical problems of Rheumatology and Immunology doctors in China were discussed in detail by using the grade classification system and the report standard of international practice guidelines (right) The purpose of evidence-based recommendation is to improve the scientificity of SLE diagnosis and treatment and improve the quality of patient-centered medical service. next Tuesday (May 12), Professor Zeng Xiaofeng will interpret the latest version of Chinese SLE diagnosis and treatment guidelines in detail for you. Please look forward to it! References: [1] expert group of China systemic lupus erythematosus research cooperation group, national rheumatology data center. Recommendations on perinatal management of patients with systemic lupus erythematosus [J]. Chinese Journal of medicine, 2015, 95 (14): 1056-1060. [2] rheumatology branch of Chinese Medical Association, national clinical research center of skin and immune diseases, Chinese Journal of internal medicine, 2020,59 (03): 172-185. Doi: 10.3760/cma.j.issn.0578-1426.2020.03.002. This information is only for medical and scientific research reference. Sanofi does not recommend any information inconsistent with the prescription approved by your country