Journal of Shandong University (Health Sciences) ›› 2021, Vol. 59 ›› Issue (8): 38-43.doi: 10.6040/j.issn.1671-7554.0.2021.0935

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Role of immunosuppressants in rheumatic disease-associated recurrent spontaneous abortion

GUO Yunfei, SHU Qiang   

  1. Department of Rheumatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2021-09-16

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Abstract: One of the main causes of recurrent spontaneous abortion(RSA)is the combination of rheumatologic diseases. In recent years, immunosuppressive agents have gradually taken the main role in the treatment of patients with RSA combined with rheumatologic diseases, and their therapeutic effects are generally recognized. Since RSA combined with rheumatic immune disease involves several disciplines, the indications and dosage of immunosuppressants need to be further standardized. In this paper, we review the existing domestic and international literature in terms of the definition of RSA, the correlation between rheumatic diseases and RSA, and the use of immunosuppressive drugs, in order to improve the readers understanding of related diseases and drugs, and to provide reference for clinicians to make rational decisions in practice.

Key words: Immunosuppressants, Recurrent spontaneous abortion, Rheumatic diseases, Rheumatoid arthritis, Systemic lupus erythematosus, Connective tissue disease

CLC Number: 

  • R593.2
[1] Eudy AM, Siega-Riz AM, Engel SM, et al. Effect of pregnancy on disease flares in patients with systemic lupus erythematosus[J]. Ann Rheum Dis, 2018, 77(6): 855-860.
[2] Sugawara E, Kato M, Fujieda Y, et al. Pregnancy outcomes in women with rheumatic diseases: a real-world observational study in Japan[J]. Lupus, 2019, 28(12): 1407-1416.
[3] 复发性流产合并风湿免疫病免疫抑制剂应用中国专家共识编写组. 复发性流产合并风湿免疫病免疫抑制剂应用中国专家共识[J]. 中华生殖与避孕杂志, 2020, 40(7): 527-534.
[4] 自然流产诊治中国专家共识编写组.自然流产诊治中国专家共识(2020年版)[J]. 中国实用妇科与产科杂志, 2020, 36(11): 1082-1090.
[5] Chen Y, Wu Q, Wei J, et al. Effects of aspirin, vitamin D3, and progesterone on pregnancy outcomes in an autoimmune recurrent spontaneous abortion model[J]. Braz J Med Biol Res, 2021, 54(9): e9570. doi: 10.1590/1414-431X2020e9570.
[6] Ceccarelli F, Pirone C, Perricone C, et al. Pregnancy outcome in systemic lupus erythematosus patients: a monocentric cohort analysis[J]. Rheumatology(Oxford), 2021, 60(4): 1747-1754.
[7] Hiramatsu Y, Isoda K, Kotani T, et al. Pre-pregnancy serum complement C3 level is a predictor of preterm birth for pregnancies with systemic lupus erythematosus[J]. Arthritis Res Ther, 2021, 23(1): 140. doi: 10.1186/s13075-021-02522-x.
[8] Zhang S, Wu Z, Zhang W, et al. Clinical performance of non-criteria antibodies to phospholipids in Chinese patients with antiphospholipid syndrome[J]. Clin Chim Acta, 2019, 495: 205-209. doi: 10.1016/j.cca.2019.04.065.
[9] Nalli C, Lini D, Andreoli L, et al. Low preconception complement levels are associated with adverse pregnancy outcomes in a multicenter study of 260 pregnancies in 197 women with antiphospholipid syndrome or carriers of antiphospholipid antibodies[J]. Biomedicines, 2021, 9(6): 671. doi: 10.3390/biomedicines9060671.
[10] Cohen H, Efthymiou M, Devreese KMJ. Monitoring of anticoagulation in thrombotic antiphospholipid syndrome[J]. J Thromb Haemost, 2021, 19(4): 892-908.
[11] Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American college of rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases[J]. Arthritis Rheumatol, 2020, 72(4): 529-556.
[12] Bröms G, Kieler H, Ekbom A, et al. Anti-TNF treatment during pregnancy and birth outcomes: a population-based study from Denmark, Finland, and Sweden[J]. Pharmacoepidemiol Drug Saf, 2020, 29(3): 316-327.
[13] Elliott B, Spence AR, Czuzoj-Shulman N, et al. Effect of Sjögrens syndrome on maternal and neonatal outcomes of pregnancy[J]. J Perinat Med, 2019, 47(6): 637-642.
[14] Spinillo A, Beneventi F, Ramoni V, et al. Prevalence and significance of previously undiagnosed rheumatic diseases in pregnancy[J]. Annals of the Rheumatic Diseases, 2012, 71(6): 918-923.
[15] Zucchi D, Tani C, Monacci F, et al. Pregnancy and undifferentiated connective tissue disease: outcome and risk of flare in 100 pregnancies[J]. Rheumatology(Oxford), 2020, 59(6): 1335-1339.
[16] de Moreuil C, Alavi Z, Pasquier E. Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage[J]. Br J Clin Pharmacol, 2020, 86(1): 39-49.
[17] Duan J, Ma D, Wen X, et al. Hydroxychloroquine prophylaxis for preeclampsia, hypertension and prematurity in pregnant patients with systemic lupus erythematosus: a meta-analysis[J]. Lupus, 2021, 30(7): 1163-1174.
[18] Yang S, Ni R, Lu Y, et al. A three-arm, multicenter, open-label randomized controlled trial of hydroxychloroquine and low-dose prednisone to treat recurrent pregnancy loss in women with undifferentiated connective tissue diseases: protocol for the Immunosuppressant regimens for LIving FEtuses(ILIFE)trial[J]. Trials, 2020, 21(1): 771. doi: 10.1186/s13063-020-04716-1.
[19] Dong Y, Lu Y, Xia Y, et al. Effect of hydroxychloroquine on antiphospholipid antibodies-inhibited endometrial angiogenesis[J]. J Matern Fetal Neonatal Med, 2021: 1-9. doi: 10.1080/14767058.2021.1943656.
[20] Ou H, Yu Q. Efficacy of aspirin, prednisone, and multivitamin triple therapy in treating unexplained recurrent spontaneous abortion: a cohort study[J]. Int J Gynaecol Obstet, 2020, 148(1): 21-26.
[21] Ince-Askan H, van den Akker ELT, de Rijke YB, et al. Associations between antenatal prednisone exposure and long-term cortisol and cortisone concentrations in children born to women with rheumatoid arthritis: results from a nationwide prospective cohort study[J]. RMD Open, 2019, 5(1): e000852. doi: 10.1136/rmdopen-2018-000852.
[22] De Cock D, Brants L, Soenen I, et al. A systematic review on the effect of DMARDs on fertility in rheumatoid arthritis[J]. Semin Arthritis Rheum, 2020, 50(5): 873-878.
[23] Huang W, Lu W, Li Q, et al. Effects of cyclosporine A on proliferation, invasion and migration of HTR-8/SVneo human extravillous trophoblasts[J]. Biochem Biophys Res Commun, 2020, 533(4): 645-650.
[24] Sharma UR, Rathnakaran AN, Raj BPP, et al. The positive effect of pregnancy in rheumatoid arthritis and the use of medications for the management of rheumatoid arthritis during pregnancy[J]. Inflammopharmacology, 2021, 29(4): 987-1000.
[25] Balbi GGM, Domingues V, Balbi GGM, et al. Use of synthetic and biologic DMARDs during pregnancy[J]. Expert Rev Clin Immunol, 2019, 15(1): 27-39.
[26] Ponticelli C, Moroni G. Fetal toxicity of immunosuppressive drugs in pregnancy[J]. J Clin Med, 2018, 7(12): 552. doi: 10.3390/jcm7120552.
[27] Yang X, Meng T. Is there a role of intravenous immunoglobulin in immunologic recurrent pregnancy loss?[J]. J Immunol Res, 2020, 2020: 6672865. doi: 10.1155/2020/6672865.
[28] Urban ML, Bettiol A, Serena C, et al. Intravenous immunoglobulin for the secondary prevention of stillbirth in obstetric antiphospholipid syndrome: a case series and systematic review of literature[J]. Autoimmun Rev, 2020, 19(9): 102620. doi: 10.1016/j.autrev.2020.102620.
[29] Prieto-Peña D, Calderón-Goercke M, Adán A, et al. Efficacy and safety of certolizumab pegol in pregnant women with uveitis. Recommendations on the management with immunosuppressive and biologic therapies in uveitis during pregnancy[J]. Clin Exp Rheumatol, 2021, 39(1): 105-114.
[30] Perrotta K, Kiernan E, Bandoli G, et al. Pregnancy outcomes following maternal treatment with rituximab prior to or during pregnancy: a case series[J]. Rheumatol Adv Pract, 2021, 5(1): rkaa074. doi: 10.1093/rap/rkaa074.
[31] Saito J, Yakuwa N, Kaneko K, et al. Tocilizumab during pregnancy and lactation: drug levels in maternal serum, cord blood, breast milk and infant serum[J]. Rheumatology(Oxford), 2019, 58(8): 1505-1507.
[32] Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus[J]. Ann Rheum Dis, 2019, 78(6): 736-745.
[33] Akhlaghi M, Kianersi F, Radmehr H, et al. Evaluation of optical coherence tomography angiography parameters in patients treated with Hydroxychloroquine[J]. BMC Ophthalmol, 2021, 21(1): 209. doi: 10.1186/s12886-021-01977-5.
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