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Reactivación y pronóstico obstétrico-neonatal en lupus y embarazo
Resumen
Objetivos: evaluar el efecto del embarazo en la actividad del lupus eritematoso sistémico, y de este en el resultado obstétrico y neonatal.
Métodos: 24 mujeres con lupus eritematoso sistémico experimentaron 37 gestaciones, de las que se obtuvieron 38 productos. En cada gestación/puerperio se compararon las reactivaciones, calificación Mex-SLEDAI y dosis de PDN, así como desenlaces obstétricos y neonatales.
Resultados: durante el embarazo/puerperio hubo mayor riesgo de recaída (RR = 11.8), mayor calificación Mex-SLEDAI (2.0 ± 2.5 adversus 01 ± 0.7) y más requerimientos de PDN (13.5 ± 12.6 adversus 7.2 ± 7.5 mg/día). Se registró 10.8 % de abortos, 5.4 % de óbitos, 18.8 % de preeclampsia y 18.9 % de premadurez. La tasa de mortalidad neonatal fue de 6 % y la perinatal, de 10.5 %. La actividad lúpica se asoció con morbilidad obstétrica (83.3 adversus 38.8 %), neonatal (46.7 adversus 11.1 %), premadurez (43.6 adversus 11.1 %) y bajo peso neonatal (25 adversus 0).
Conclusiones: ante embarazo y lupus eritematoso sistémico hay más y más intensas reactivaciones y requerimientos de glucocor-ticoides. El pronóstico obstétrico y neonatal es más adverso.
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