الفهرس 
ACKNOWLEDGEMENT
IntroductionOnly 14 pages are availabe for public view
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Abstract
Patients suffering from autoimmune rheumatic disorders are predominantly young women between the ages of 20 and 40 years, which is the period of the highest child-bearing potential.The impact that these diseases and their therapies have on pregnancy and, conversely, the effect of pregnancy on these disorders, which may have long-lasting implications for mothers and neonates.
Connective tissue diseases (CTDs) comprise a group of systemic autoimmune diseases characterized by antinuclear antibodies (ANA). These include a proportion of up to one fourth of undifferentiated CTDs. In contrast, the specific CTDs, namely (SLE), (SS), Sjoegren’s syndrome, mixed connective tissue disease (MCTD) have more precise classification criteria, even though their clinical symptoms show high variance.Evidence of autoantibodies is an important prerequisite for the diagnosis of autoimmune disease, but not all detected autoantibodies are necessarily of pathophysiological relevance. On the other hand, the proof of pathogenicity for some of these autoantibodies is an important finding that clearly strengthens their relevance for disease.
The established therapies such as glucocorticoids, non-specific immunosuppressive and chemotherapeutic agents are now being tested against newer and more targeted biologic and molecular therapies.
It is important to highlight that many changes noticed in neonatealready started in the fetal life, making difficult a clear separation betweenpathology of the fetus and of the neonate.Pregnancy can result in full term or preterm live birth delivery, orin fetal loss.
The knowledge that rheumatologic diseases have an extensive impact on several organs and systems of patients and the studies aiming at the assessment of sexual and reproductive function show important results for clinical conduction due to the multifactorial origin and by the negative impact of the disease on the quality of life of patients of both sexes.
Almost all drugs coming into breast milk, with the exception of insulin and low molecular weight heparins, and passage is usually by passive diffusion and use of any topical medication such as creams, nasal sprays or inhalers provide less risk to infants than drugs administered systemically. Breastfeeding is not contraindicated with the use of steroids, but if the dose is greater than 40 mg daily breastfeeding should be considered 4 h after ingesting the drug. Cyclosporine, tacrolimus, cyclophosphamide, MTX, leflunomide, mycophenolate, chlorambucil, gold salts and biological agents are not compatible with breastfeeding.
Pregnancy can be particularly risky in women with active rheumatologic disease or on teratogenic medications, making contraception an important issue for these women.It is particularly important to discuss contraception with patients early and often for several reasons. Women with rheumatologic diseases do not have a higher rate of infertility than the healthy population.All women with rheumatologic disease have contraceptive options, including barrier methods, the intra-uterine device (IUD) and progesterone-only medications.
The effects of antiinflammatory and immunosuppressive drugs on male gonadal function, particularly spermatogenesis, may be affected by these drugs as well.Drug-induced infertility in men, such as that seen with alkylating agents, results from the toxic or suppressive effects of the medications on the testes.The effect on sperm production is drug-specific, dose-dependent, and duration-dependent.When a drug has adverse effects on sperm production and function, there is concern that the exposure could also affect fetal outcome. However, unlike teratogenic agents affecting pregnant women, in the male, they do not seem to directly interfere with normal fetal development.