title: [Chronic maternal diseases and pregnancy losses. French guidelines].
abstract: OBJECTIVE
  To review the available data on maternal chronic diseases and pregnancy losses.
  
  
  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.
authors.affiliation: Service de gynécologie-obstétrique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm U1150, CNRS UMR 7222, UPMC université Paris 06, Sorbonne universités, 75005 Paris, France. Electronic address: jacky.nizard@psl.aphp.fr.
authors.forename: J
authors.initials: J
authors.lastname: Nizard
authors.affiliation: Service de médecine interne, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: G
authors.initials: G
authors.lastname: Guettrot-Imbert
authors.affiliation: Unité de gynécologie endocrinienne, maternité Port-Royal (AP-HP), 53, avenue de l'Observatoire, 75014 Paris, France; Unité d'hémostase, hôpital Cochin (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Plu-Bureau
authors.affiliation: Service de nutrition, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Service de diabétologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ciangura
authors.affiliation: Service de diabétologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Jacqueminet
authors.affiliation: Unité thyroïde - tumeurs endocrines, institut d'endocrinologie E3M, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Leenhardt
authors.affiliation: Service de gynécologie-obstétrique, hôpital Antoine-Béclère (AP-HP), 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: S
authors.initials: S
authors.lastname: Nedellec
authors.affiliation: Service de gynécologie-obstétrique, hôpital Antoine-Béclère (AP-HP), 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: V
authors.initials: V
authors.lastname: Gallot
authors.affiliation: Unité de cytogénétique, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; EA 2493, UFR des sciences de la santé, 2, avenue de la Source-de-le-Bièvre, 78180 Montigny-le-Bretonneux, France.
authors.forename: F
authors.initials: F
authors.lastname: Vialard
authors.affiliation: Service de gynécologie-obstétrique, CHI Poissy-Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78300 Poissy, France.
authors.forename: T
authors.initials: T
authors.lastname: Quibel
authors.affiliation: Service de gynécologie-obstétrique, CHI Poissy-Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78300 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: C
authors.initials: C
authors.lastname: Huchon
authors.affiliation: Centre de référence maladies auto-immunes et maladies systémiques rares, service de médecine interne, pôle médecine, hôpital Cochin, université René-Descartes Paris-V, AP-HP, 27, rue du Faubourg-Saint-Jacques, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Costedoat-Chalumeau
mesh_terms: D000022:Abortion, Spontaneous / Q000517:prevention & control*; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D005602:France; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*
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