Gravidez e as doenças reumáticas
DOI:
https://doi.org/10.24220/2318-0897v1a1992e1442Resumo
Rheumatic diseases occur frequently in women of childbearing ageI. Many of these disorders occur in women who are pregnant or desire to become so. Collectively, problems ofpregnancy are common and varied among these disorders. They may range from minor exacerbations of low back pain in women with HLA-B27 related spondyloarthropathy to life-thereatening, progressive glomerulonephütis in patients with either systemic lupus erythematosus (SLB) or systemic sclerosis (SSe) who have active renal involvement or patients with serious postpartum thromboembolic events associated with antiphospholipid syndromes.
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MASI, A. T. & MEDSGER Jr., T. A. Epidemiology of the rheumatic diseases. In: MCCARTY, D.J. (ed). Arthritis and allied conditions . 11.ed. Philadephia; Lea & Febiger, 1989, p. 16-54
BURROW, G.N. & FERRIS, T.F: Medical complications during pregnanc) . 3. ed. Philadelphia; W.B. Saunders Co., 1988.603 P
NELSON, NM: Current therapy in neonatal-perinatal medicine-2 . Toronto; B.C. Decker, Inc., 1990, 506p.
ZURIER, RB. (ed). Pregnancy in patients with rheumaüc diseases. Rheum Dis Cliff N Am., 15:193-403, 1989.
McCARTY, D.J. (ed) Anhritis and allied conditions : a textbook of rheumatology. 11. ed. Philadelphia; Lea & Febiger, 1989, 2045 P
KELLEY, W.N. HARRIS Jr. ed. RUDDY, S; SLEDGE, C.B. (eds). Textbook ofrheumatology . 3. ed. Philadelphia; W.B. Saunders Company, 1989, 21«t p,
DOMBROSKI, R. A. Autoimmune disease in pregnancy. MED. CLnq. N. AM.; 73:605-621, 1989
CECERE, F.A. & PERSELLIN, RH. The interaction of pregnalcy and the rheumatic diseases. CLIN RHEUM. DIS; 7:747-768. 1981
HENCH, P.S. The ameliorating effect of pregnancy on ctuonic atrophic (infectious rheumatoid) arthritis, fibrositis, and intermittent hydrarthrosis. Proc Staff Meetings Mayo Cbn., 13:161-167, 1958..
OSTENSEN, M.; AUNE, B.; HUSBY, G. Effect of pregnancy and hormonal changes on the activity ofrheumatoid arthirits. Scand. J. Rheumatol., 12-69-72, 1983.
KLIPPLE, G.L. & CECERE F. A. Rheumatoid arthritis and pregnancy. Rheum Dis Cliff N Am., 15:213-239, 1989.
OKA. M. Effect of pregnancy on the onset and course of rheumatoid arthútis. Ann Rheum Dis. 12:227-229, 1953.
FELBO, M. & SNORRASON, E. Pregnancy and the place of therapeutic abortion in rheumatoid arthritis AcM Obsetet Gynecot Scand., 40: 1 16- 126, 1961 .
BULMASH, J .M. Rheumatoid arthritis and pregnmcy. Obstet Gynecol Annu., 8:223-276, 1979.
NOLTEN, W.E. & Rueckert P. A. Elevated free cortisol index in pregnancy: possible regulatory mechanisms. Am J Obstet et Gynecot ., 139:492-498, 1981.
OSTENSEN, M. & HUSBY, G. A prospective clinical study of the effect of pregnancy on rheumatoid arthdtis and ankylosing spondyhtis. Arthritis Rheum., 26: 1 155- 1159, 1983.
BRABIN, B.J. Epidemiology of infection in pregnancy. Rev Infect Dis., 7:579:603, 1985
SRIDAMA, V.; PACINI, F.: YANG, S.L. et al. Decreased levels of helper T cells: a possible cause of immunodeficiecy in pregnancy. N. Eng . J Med., 307:352-356 1982..
KRAUSE, P.J.; INGARDI, C.J.; PONTIUS, L.T. et al: Host defende during pregnancy: neutrophil chemotaxis and adherence. am J Obstet Gynecot ., 157:274-280, 1987.
OSTENSEN, M.; REVHAUG. A.; VOLDEN. G. et al. The effect on pregnancy of functions ofinflammatory cells in healthy women and in patients with rheumatic diseases. Acta Obstet Gynecol Scand 66:247-253, 1987.
UNGER, A.; KAY, A.; GRIFFIN, A.J. et al. Disease activity and pregnancy associated alpha 2-glycoprotein in rheumatoid arthdtis during pregnancy. Br Med J (Clin Res), 5:750-752, 1983
OSTENSEN, M.; VON SCHOULTZ, BL; HUSBY, G. Comparison between serum alpha 2 pregnancy-associated globulin and activity of rheumatoid arthdtis and ankylosing spondylitis during pregnancy. Scand J Theumatol: 12:315-318, 1983.
HERNANDEZ-AVILA, M.; LIANG, MH.; WiLLEm, WC. et al. Exogenous sex hormones and the risk of rheumatoid arthritis. Arthritis Rheum., 33:947-953, 1990.
NELSON, J.L.; NISPEROS, B.B.; HUGHES, KA,; HANSEN, J.A. Maternal-fetal disparity for HLA-DQ antigens is associated with the pregnancy induced remission of rheumatoid arthiritis. Arthritis Rheum., 33:Slo, 1990.
WHITE, C.A. Collagen disease in pregnancy. In: Sciarra, J.J. (ed). Gynecolog) and obsttetrics , vol. 3. Hagerstown, Harper and Row, 1980.
YOSHTNO, S. & UCHIDA, S. Sexual problems of women with rheumatoid arthritis. Arch Phys Med Rehab., 62: 122- 123, 1981
KAY, A.: & BACH, F. Subfertility before and after the development ofrheumatoid arthdtis in women. Ann Rheum Dis., 24: 169- 173, 1965
MASI, A.T.; JOSIPOVIC, DB.; JEFFERSON, W.E. Low adrenal androgenic-anabolic steroids in women with rheumatoi arthdtis (RA): gas-liquid chromatographic studies of RA patients and matched normal control women indicating decreased Il-deoxy-17-ketosteroid excretion. Semin Arthritis Rheum., 14:1-23, 1984.
SSILMAN, A.J. Is pregnancy a risk factor in the causation of rheumatoid arthdstis? Ann Rheum Dis., 45: 1031-1034, 1986.
ENGEL, A. Rheumatoid arthristis in U.S. adults 1960-1962. In: BENNET, PH. & WOOD, P.H.N. (eds). Population studies in the rheumat ic dIseases. Amsterdam, Excerpta Medica Foundation, 1968, p. 83-89.
MUSE:Y, VC.; COLLINS, DC.; BROGAN, DR. et al. Long term effects of a first pregnancy on the hormonal environment: estrogens and androgens. J Cbn Endocrin Metab ., 64: 1 1 1-118, 1987
GAO, X.; OLSEN, N.J.; PINCUS, T.; STASTNY, P. HLA-DR alleles with naturaly occurring amino acid substitutions and risk for development of rheumatoid arthristis. Arthristis Rheum, 33:939-946, 1990.
LEE, P. Anti-inflammatory therapy during pregnancy and lactation. Cbn Invest Med., 8:328-332, 1985.
SIBI, B.M.; MIRRO, R.; CHESNEY, C.M.; LEFFLER, C. Low-dose aspirin in pregnancy. Obstet Gynecot ., 74:551-557, 1989.
THC)RP, J.A.; WALSH, S. W.; BRATH, PC. Low-dose aspirin onhibüis thromboxane, but not prostacyclin, production by human placental aneries. Am J obstet Gynecol, 159: 1381-1384, 1988
SLONE, D.'; HEHqONEN, O.P.; SISKIND, V.; MONSON, R.R.; KAUFMAN, D. W.; SHAPIRO, S. Aspirin and congenital malformations. Lancer, 1:1373-1376, 1976.
HEINONEN, O.P; SLONE, D.; SHAPIRO, S. Birth defects and drugs in Pregnancy . Littleton, Mass., Publishing Sciences Group, 1977, 516p..
ROUBENOFF, RL; HOW, j.; PETRI, M.; HOCHBERG, M.C.; HELLM ANN, D.B. Effects of anti-inflammatory and immunosuppresive drugs oon pregnancy and fertility. Semin Arthristis Rheum., 18:88-110, 1988.
WERLER, M.M.; MITCHELL, A. A.; SHAPIRO, S. The relation os aspüin use during the first üimester ofpregnancy to congenital cardiac defcts. N Engl J Med., 321:1639- 1642, 1989,
FDA. Labeling for oral and rectal over-the-counter aspirin and aspirin-contagining drug products; final rule. Federal Regsiter ,55 (120):27776-27784, 1990
GABBE, S.G. Drug Therapy in autoimmune diseases. C lin Obstet Gynecot ., 26:635-G11, 1983.
ULLBERG, S.; LINDQUIST, N.G.; SJÔSTRAND, S.E. Accumulation of chorio-retino-toxic drugs in the foetal eye. Nature , 227: 1257-1258, 1970.
PARKE, A. Antimalarial drugs and pregnancy. Am J Med1 85(Suppl 4A):30-33, 1988
HART, C. W.; NAUIVFON, R.F. The ototoxicity of chloroquine phosphate. Arch Otolaryngol ., 80:407-412, 1984.
MJOLNEROD, O.K.; RASMUSSEN, K.; DOMMERUD, S. A.; GJERULSEN, S. T. Congenital connective-tissue defect. probably due to D-penicillamine treatment in pregnancy. Lancer, 1 :673-675, 1971.
SOLOMON, L.; ABRAM, G.; DINNER, M. et al. Neonatal abnormalites associated with D-Penicilliamine treatment during pregnancy (Letter). N Engl J Med, 296:54-55, 1977.
ENDRES, W. D-Penicillamine in pregnancy: to ban or not to ban? Klin W ochenschr , 59:535-537, 1981
MILUNSKY, A.; GRAEF, J. W.; GAYNOR Jr., M.F Methotrexate-induced congenital malformations. J Pediatr , 72:790-795, 1968
MASI, A. T.; MEDSGER, T. A. A new look at the epidemiology of ankylosing spondylitis and related syndromes. Cbn Orthop , 143:15-29, 1979.
GRAN, J.T.; HUSBY, G.; HORDVIK, M. Prevalence of ankylosing spondylitis in males and females in a young middle-aged population of Trosm, northern Norway. Ann. Rheum Dis., 44:359-367, 1985
HART, F.D. Bechterew ’s syndrome in women: is it different from that in men? Scand. J. Rheumatol, 32:38 '40, 1980.
GOODMAN, C.E.; LANGE, R.K.; WAXMAN, J. et al. Ankylosing spondylitis in women. Archt Phys Med Rehab , 61:167-170, 1980.
GRAN, J.T.; OSTENSEN, M.; HUSBY, G. A clinical comparison between males and females with ankylosing spondylitis. J. Rheumatol, 12: 126- 129, 1985
GRAN, J.T. & HUSBY, G. Ankylosing spondylitis in women. Semin Arthrit is Rheum, 19:303-3 12, 1990.
OSTENSEN, M. & HUSBY, G. Stensen M, Husby G: Ankylosing spondylitis and pregnancy. Rhem. Dis . Cliff. N. Am., 15:241-254, 1989
OSTENSEN, M.; ROMBERG, O.; HUSBY, G. Ankylosing spondylitis and motherhood. Arthristis Rhem, 25:140-143, 1982
OSTENSEN, M. & HUSBY, G. Pregnancy and rheumatic disease: a review of recent studies in rheumatoid arthristis and anklosing spondylitis. Klin W ochenschr ., 62:891-895, 1984.
VEILLE. J.C.: HOHIMER, A.R.: BURRY, K. et al. The effect of exercise on uterine activity in the last eight weeks ofpregnancy. Am. J. Obstet. Ginecol., 151:727-730, 1985.
OSTENSEN, M. & HUSBY, G. Antirheumatic drug treatment during pregnancy and lactation. Scand. J. Rheum., 14: 1-7, 1985.
FRAGA, A.; MI]VFZ, G.; OROZCO, J.; OROZCO, J.H. Sterility and fertility rates, fetal wastage and maternal morbidity in systemic lupus erythematosus. J. Rheumatol., 1:293-298, 1974.
WALLACE, D.J. & DUBOIS, EL. Lupus, pregnancy, and neonatal lupus. In: Wallace, D.J. & Dubois, E.L. (eds). Dubois' Luppus Erythenatosus. 3. ed. Philadelphia, Lea & Fediger, 1987, p. 565-579.
ZURIER, R.B. Systemic lupus erythematosus and pregnaancy. In: Lahita, R.G. (ed). Sisternic lupus erythematosus . New York, Jonh Wiley & Sons, 1987, pp 541-554.
MINI:Z, G. & RODRiGUESZ- ALVAREZ, E. Systemic lúpus erythematous. Rheum. Dis . Cliff. N. Am., 15:225-274, 1989.
LOCKSHIN, M.D. Pregnancy does not cause systemic lúpus erythematous to worsen. Arthristis Rheum., 2:667-670, 1989.
MINTZ, G.; NIZ, J.: GUriERREZ, G. et al. Prospective study of pregnancy in systemic lupus erythematosus. results of a multidisciplinary approach. J Rheurnatol, 13:732-739, 1984.
LOCKSHIN, M.D.; REINFFZ, E.; DRUZIN, M.L. et al. Lupus pregnancy; case-control prospective study demonstrating absence of lupus exacerbation during pregnancy. Am J Med., 77:893-898, 1984.
ZURIER, R.B.; ARGYROS, T.G.; URMAN, J.D. et al. Systemic Lupus erythematosus management during pregnancy. Obstet Gynecot ., 51: 178-180, 1978.
FINE, L.G.; BARNEm, E. v.; DANOVFI:ICH, G.M. et al. Systemic lupus erythematosus in pregnancy: UCLA conference. Ann Intern Med., 94:667-677, 1981.
LOCKSHIN, M.D.; DRUZIN, M.L.; GOEI, S. et al. Antobody to cardiolipin as a predictor of fetal distnss or death in pregnant patients with systemic lupus erythematosus. N ErrEI J Med., 313: 152-156, 1985.
ISHII, Y.; NAGASAWA, K.; MAYUNI, T.; Y. Clinical importance of persistence of anticardiolipin antibodies in systemic lúpus erythematosus. Ann Rheum Dis ., 49:387-390, 1990.
ABRA,PWSLU. C.R.; VEGAS, M.E; SWINEHART, G. Gynves, M. T. Decidual vasculopathy of the placenta in lúpus erythematosus. New End . J. Med., 303:668-672, 1980.
HANLY. J.G.: GLADMAN. D.D.: ROSE. T.H.: LASKIN. C. A.: UROWII:Z, M. B. Lupus pregnancy: a prospective study of placental changes. Arthristis Rhem., 31:358-366, 1988.
GRIGOR. R.R.: SHERVINGTON. P.C.: HUGHES. G.R. V. et al. Outcome ofpregnancy in systernic lupus erythematosus. Proc . R. Soc . Med., 70:99-100, 1977.
BUYON, J. & SZER, I. Buyon J, Szer I. Passively acquired autoimmunity and the maternal fetal dyad in systemic lúpus erythematosus. Springer Semin. Immunopathol., 9:283-304, 1986
WATSON. R.M.; LANE. A.T.: BARNEU, N.K. et al. Neonatal lupus erythematosus: a clinical, serological and immunogenetic study with review of the literature. Medicine , (Baltimore), 63: 362-378, 1984.
LOCKSHIN. M.D.: BONFA. E.; EILKON. D.: Druzin. M.L. Neonatal lupus risk to newborns of mothers with systemic lúpus erythematosus. Arthristis Rheum., 31 :697-701, 1988.
LEVFI:Z, M.; JANSEN, V.; DANCIS, J. The transfer and metabolismo of corticosteroids in the perfused human placenta. Am J Obstet Gynecol., 132:363-366, 1978.
BOWIE. E.J.; THOMPSON JR., J.H; PASCUZZI, C.A. et al. Thrombosis in systemic lupus erythematosus despite circulating anticoagulants. J. Cliff. Lab . Med., 62:416-430, 1963.
NELSSON, l.M.; ASTEDT, B.; HEDNER, U.; BEREZHq, D, Intrauterine death and circulating anticoagulante (“antithromboplastin”). Acra Med. Scand. 197:153-159, 1975
HARRIS; E.N.: CHAN. J.K.H.: ASHERSON, R.A.; ABER, V.R.; GHARAVI. A.E.: HUGHES, G.R.V. 'l'hllnobosis, recurrent fetal loss, and thrombocytopenia. predictive value of the anticardiolipin antibody test. Arch. Intern. Med. 146:2153-2156, 1986.
PARKE, A.L. Antiphospholipit antibody syndromes. R}team. Dis. Clin. N. Am. 15:275-286, 1989.
LOVE, P.E. & SAMORO, S.A. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lúpus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significante. Ann. Intern. Med., 112:682-698, 1990.
SAMMAREITANO, L.R.; GHARAVI, A.E.; LOCKSFHN, M.D. Antiphospholipid antibody syndrome: immunologic and clinical aspects. Sernin Arthristis Rheum. 20:81-96, 1990.
BRANCH, D.W.; SCOH. J.R.: KOCHENOUR, N.K. et al. Obsteüic complications associated with the lupus anticoagulant. N. Eng. J. Med., 313:1322-1326, 1985.
KOSKELA, p.: VAARAT.A. o.; MÂKrrALO, R.; PALOSUO. T.; AHO, K. Significance of false positive syphilis reactions and anticardiolipin 'antibodies in a nationwide series of pregnant wonen. J. Rheumatol. 15:70-73, 1988.
HARRIS, E.N.; GHARAVI, A.E.; PATEL. S.P.; HUGHES, G.R.V.: Evaluation of the anticardiolipin antibody test: report of na international workshop held 4 april 1986. Cbn. Exp. Immunol., 68., 215-222, 1987.
ASHERSON, R.A.; KHAMASHFA, M.A.; ORDi-ROS, J. et al. The “primary” antiphospholipid syndrome: major clinical and serological features. Medicine (Baltimore), 68:366-74, 1989
QAMAR, T.; LEVy, R.A.; SAMMARrrANO, L.; GnARAVI, A.E.; LOCKSHIN, MD. Characteristics of high-titer IgC antiphospholipid antibody in systemic lupus erythematosus patients with and without fetal deach. Arthristis Rheum., 33:501-504, 1990
KHAMASHTA, M.A.; HARRIS, E.N.; GHARAVI, A.E. et al. Immune mediated mechanism forthrombosis: antiphospholipid antibody bincüng to piatelet membranes. Alm. Rheum, Dis„ 47:849-854, 1988
MUEH. J.R.; HERBST. KD.: RAPAPORT. S.I. Thrombosis in patientes with the lupus anticoagulant. Ann. Intern. MedI , 92: 156-159, 1980.
BOEY, M.L.; COLACO, C.B.; GHARAVI, A.E. et al. Thrombosis in systemic lupus erythematosus: striking association with the presence of circulating lupus anticoagulant. Br. Med. J., 287 : 1021-1023 , 1983
ANGLES-CANO, E.; SULTAN, YL; CLAWEL, J.P. Predisposing factors to thrombosis in systemic lupus erythematosus: possible relation to endothelial cell damage. J. Inb . Cliff. Med., 94:312-323, 1979.
HARRIS, E.N. & SPINNATO, J. Should sera of healthy pregnant women tn screened for anticardiolipin antibodies? Arthritis Rheum,, 33 (Suppl.) 528, 1990.
REECE, E. A.; GAMBRIELLI, S.; CULLEN, M.T. et al. Recunent àdverse pregnancy outcome and antiphosphobpid anübodies. Am. 7. Obstet . Gynecol., 163:162-169, 1990.
MAKAR. A. Ph.: VANDERHAYDEN, J.S. VERHEYEN, A. Material and fetal complications associating lúpus anticoagulant and its management: three case reports. Europ . 7. Obstet . Gynecol. Reprod. Med., 36:185-195, 1990
DRUZIN. M.L.: LOCKSHIN, M.D., EDERSHEIM, T.G. et al. Second-trimester fetal monitoring and preterm delivery in pregnancies with systemic lupus erythematosus and/or circulating anticoagulant. am. 7. Obstet . G)necot . , 157:1510, 1987
LUBBE, w.F; BUTLER, w.s.; PALMER, s.J.; LiGGmqs, G.c. Lupus anticoagulant in pregnancy. Br. J. Obstet , Gynecot ., 91:357-363, 1984
LOCKSHIN, M.D.; DRUZIN, M.L.; QAMAR, T. Prednisone does not prevent recurrent fetal death in women with antiphospholipid antibody. Am. 7. Obstet . Gynecol ., 160;439-443. 1989
ROSOVE, M.H.; TABSH, K.; WASSERSTRUM, N. et al. Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies. Obstet . Gynecol ., 75:630-634, 1990.
STAFFORD-BRADY, F.J.; GLADMAN, DD.; UROwrrz, M.B. Successful pregnancy in systemic lupus erythematosus with na untreated lupus anticoagulant. Arch. Int . Med., 148:16+7- 1618, 1988
SCOT. JR.; BRACH, D.W.; KOCFBNOUR, N.K. et al. Inüavenous ilmnunoglobulin treatment of pregnant patients with recurrent pregnancy loss caused by antiphospholipid antibodies and Rh inununization. Am. 7. Obstet . Gynecol . , 159: 1055-1056, 1988.
PARKE. A.: MAIER, D.; WILSON, D. et al. Intravenous gamma-globulin, antiphospholipid antibodies, and pregnancy (Letter). Ann, Intern. Med., 110:495-496, 1989.
PLOTZ, P.H.,; DALAKAS, M.; LEFF, R.L. et al. Current concepts i the idiopathic inflammatory myopathies: polymyositis, dermatomyositis, and related disease: NIHD Conference. Ann. Int ern. Med., 111:143-157, 1989.
BUNCH, TW.; Polymyositis: a case history approach to the differential diagnosis and treatrnent. Mayo Clin. Proc., 65: 1480-1497, 1990.
ROSENZWEIG, B.A.; Rotmensch S. Binette SP, Phillippe M: Primary idiopathic polymyositis and dermatomyositis complicating pregnancy: diagnosis and management. Obstei. Gynecol. Surv., 44: 162-170, 1989.
MINTZ, G. Dermatomyositis. Rheum. Ois. Clin. North. Am., 15:375-382, 1989.
TSAI, A.; LINDHEIMER, M.D.; LAMBERG, S.I. Dermatomyositis complicating pregnancy. Obstei. Gyneco/., 41:570-573, 1973.
BA YER, K.A.; SIEGLER, M.; LINDHEIMER, M.A. Polymyositis complicating pregnancy. Arch. lntern. Med., 139:449, 1979.
KATZ, A.L. Another case of polymyositis in pregnancy (Letter). Arch. lntern. Med., 140:1123, 1980.DITZIAN-KADANOFF, R.; REINHARD, J.D.; THOMAS, C.; SEGAL, AS. Polymyositis with myoglobinuria in pregnancy: a report and review of lhe literature. J. Rheumatol, 15:513-514, 1988.
ENGLAND, M.J.; PERLMANN, T.; VERIA VA, y. Dermatomyositis in pregnancy: a case report. J. Reprod.Med.,31 :633-636, 1986.
GUTIERREZ, G.; DAGNINO. R.; MINTZ, G. Polymyositis/dermatomyositis and pregnancy. Arthritis Rheum., 27:291-294, 1984.
MASI, A.T. Clinical-epidemiologic perspective of systemic sclerosi (scleroderma). In: JA YSON, M.I.V. & and Black, C.M. (ed.) Systemic Sc/erosis-Sc/eroderma. Sussex, England, John WiJey and Sons Ltd., p. 7-31. 1988.
BALLOU, S.P.; MORLEY, J.J.; KUSHNER, I. Pregnancy and systernic sclerosis. Arthritis Rheum., 27:295-298, 1984.
KITRIDOU, RC. Pregnancy in mixed connective tissure disease, poly/dermatomysitis and scleroderma. Clin. Exp. Rheumatol., 6: 173-178, 1988.
SIAMOPOULOU-MA VRIDOU, A.; MANOUSSAKIS, M.N.; MA VRIDIS, A.K.; MOUTSOPOULOS, H.M. Outcome of pregnancy in patients with autoimmune rheumatic disease before the disease onset. Ann. Rheum. Ois., 47:982-987, 1988.
STEEN, V.D.; CONTE, C.; DAY, N.; RAMSEY-GOLDMAN, R.; Medsger Jr., T.A. Pregnancy in women with systemic sclerosis. Arthritis Rheum., 32:151-157, 1989.
BLACK, C.M. & STEVENS W.M. Scleroderma. Rheum. Dis. Clin. NorthAm., 15:193-212.
MAYMON, R. & FEJGIN, M. Scleroderma in pregnancy. Obstei. Gynecol. Surv., 44:530-534, 1989.
GIORDANO, M.; VALENTINI, G.; LUPOLT, S.; GIORDANO, A. Pregnancy and systernic sclerosis (Lener). Arthritis Rheum., 28:237-238, 1985.
abortion and infertility in women with scleroderma before disease onset: a controlled stydy. Ann. Rhe11m. Dis, 47:441-44, 1988.
MCHUGH, N.J.; REILLY, P.A.; MCHUGH, L.A. Pregnancy outcome and autoantibodies in connective tissue disease. J. Rheumatol., 16:42-46, 1989.
KAHL, L.E.; BLAIR, CL; RAMSEY-GOLDMAN, R. STEEN, V.D. Pregnacy outcomes in women with primary Raynaud's phenomenon. Arthritis Rhe11m., 33:1249-1255, 1990.
FEIGENBAUM, S.L.; MARTIN, M.C.; WILSON, C.B.; JAFFE, R.B. Lympholytic adenohypophysitis: a pituitary mass lesion occurring in pregnancy. Am. J. Obstei, Gyneco/., 164, 1991 (in press)