Consultation préconceptionnelle dans les maladies auto-immunes systémiques

Abstract

Many systemic autoimmune diseases and chronic inflammatory rheumatic conditions affect women of childbearing age. Pregnancy is most often possible, with generally acceptable fetal-maternal risks. So, pregnancy wish must be regularly sought and the optimal timing of pregnancy is essential. Women should be reassured that a good pregnancy outcome is generally possible if conception occurs in a stable remission state. The planification is ideally carried out during a preconception counseling appointment in order to look for possible contraindications (infrequent) and risk factors for obstetrical complications (previous obstetrical complication, antiphospholipid biology or syndrome, activity of the disease at conception, and definite organ failure) in order to optimize the management. The most frequent obstetrical complications are fetal losses and/or consequences of placental insufficiency. Anti-SSA and/or anti-SSB antibodies exposes to a low risk of fetal atrioventricular block. Adequate drugs adjustment should be done before conception to avoid an early relapse and to replace teratogenic drugs. Finally, organization of the follow up of this future pregnancy need to be defined in a multidisciplinary approach and explained to the patient at this time.