[Chronic maternal diseases and pregnancy losses. French guidelines]

Abstract

Aim: To review the available data on maternal chronic diseases and pregnancy losses.

Material and methods: We searched PubMed and the Cochrane library with pregnancy loss, stillbirth, intrauterine fetal demise, intrauterine fetal death, miscarriage and each maternal diseases of this paper.

Results: Antiphospholipid antibodies (anticardiolipin, anti-beta-2-glycoprotein, lupus anticoagulant) should be measured in case of miscarriage after 10WG confirmed by ultrasound (grade B) and an antiphospholipid syndrome should be treated by a combination of aspirin and low-molecular-weight heparin during a subsequent pregnancy (grade A). We do not recommend testing for genetic thrombophilia in case of first trimester miscarriage (grade B) or stillbirth (grade C). Glycemic control should be a goal before pregnancy for women with pregestational diabetes to limit the risks of pregnancy loss (grade A) with a goal of prepregnancy HbA1c<7%. Overt and subclinical hypothyroidisms should be treated by L-thyroxin during pregnancy to reduce the risks of pregnancy loss (grade A). Women who are positive for TPOAb should have TSH concentrations follow-up during pregnancy and subsequently treated by L-thyroxin if they develop subclinical hypothyroidism (grade B).

Conclusions: Prepregnancy management of most chronic maternal diseases, ideally through prepregnancy multidisciplinary counseling, reduces the risks of pregnancy loss.

Keywords: Antiphospholipid syndrome; Chronic maternal disease; Diabetes; Diabète; Fausse couche; Lupus; Maladie maternelle chronique; Miscarriage; Mort fœtale in utero; Obesity; Obésité; Perte de grossesse; Pregnancy loss; Stillbirth; Syndrome des antiphospholipides; Thrombophilias; Thrombophilies.