Schwangerschaft und Autoimmunerkrankungen – Was gilt es zu beachten?

Frauen mit Autoimmunerkrankungen und Kinderwunsch sollten präkonzeptionell ausführlich über das spezifische Risiko für ihre Erkrankung und die Schwangerschaft beraten werden. Die Schwangerschaft sollte geplant werden und in der Remission sowie gegebenenfalls unter Anpassung der Medikation eintreten. In der Schwangerschaft sollten Ärzte ein sonografisches Organscreening sowie engmaschige Verlaufskontrollen bei Mutter und Kind durchführen. Dadurch können sie Komplikationen wie die Präeklampsie, vorzeitige Wehen oder eine intrauterine Wachstumsretardierung rechtzeitig erkennen und behandeln. Die Geburt bedarf in Einzelfällen besonderer Überwachungsmaßnahmen, eine primäre Sectio caesarea ist in den meisten Fällen jedoch nicht notwendig. Im Wochenbett sind Schübe nicht selten – eine prophylaktische medikamentöse Therapie oder die Wiederaufnahme der Medikation muss dann bei der Beratung für oder gegen das Stillen berücksichtigt werden.

Women with autoimmune disorders who plan to have children should be thoroughly counseled before conception about the specific risk for their disorder and the pregnancy. Pregnancy should be planned for the time of disease remission and optimized drug regime. During pregnancy, specialized antenatal ultrasound should be performed to exclude malformations. Frequent monitoring of mother and fetus are necessary for early diagnosis and treatment of pregnancy complications such as preeclampsia, preterm labor or intrauterine growth retardation. In special cases, maternal or fetal surveillance during parturition is needed, elective cesarean section is mostly not indicated. Post partum flares are frequent, a prophylactic treatment or the re–beginning of the treatment before pregnancy should be taken into consideration when discussing whether or not the patient is advised to breastfeed.

autoimmune disorders - pregnancy - systemic lupus erythematosus - antiphospholipid syndrome - myasthenia gravis - multiple sclerosis

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