Pregnancy with an Autoimmune Disease

The relationship between pregnancy and autoimmune disease is complex, inconsistent, and influenced by many factors.

Certain autoimmune diseases may worsen during pregnancy, resulting in complications in both the mother and the fetus and even causing problems during and after childbirth. Other autoimmune diseases may improve during pregnancy and pose no harm (1, 2). Also, because many autoimmune diseases begin to manifest in women of childbearing age, identifying pregnancy as a major trigger in initial disease development may be difficult (2).

Can Pregnancy Trigger Autoimmune Disease Flare-Ups?

Yes. Pregnancy can sometimes trigger flare-ups of autoimmune diseases, though the risk and severity depend on the condition and the individual.

The development of signs, symptoms, and flare-ups of autoimmune diseases during pregnancy is unpredictable. It varies from person to person and depends on the specific type of disease. Some flare-ups can be severe, such as nephritis, which is more frequently observed in women with systemic lupus erythematosus and a history of kidney disease (3). The reasons behind the diverse effects of pregnancy on autoimmunity and autoimmune disease remain uncertain but could be connected to the intricate immunologic changes that take place in the body during pregnancy. These changes may affect both mother and fetus (2).

Are Biologics and Other Autoimmune Medications Safe During Pregnancy?

Some biologics and autoimmune medications can be safe in pregnancy, while others pose risks to the fetus and should be discontinued under medical guidance.

Discontinuing medications that may be harmful to the developing fetus may trigger flare-ups of autoimmune diseases such as lupus, ulcerative colitis, and psoriasis (4, 5). Therefore, health providers should carefully assess the use or interruption of any treatment during pregnancy.

In the realm of autoimmune diseases, biologics are therapeutic interventions that modify parts of the immune system and improve the well-being of patients. Biologics include a range of treatments, including immunomodulatory drugs, proteins, and monoclonal antibodies.

In a 2022 study, researchers assessed the effects of biologics on pregnant women with immune-mediated inflammatory disease (4). The study aimed to compare disease outcomes between pregnant women who continued to receive biologics and those who stopped taking them. Women who continued to use biologics were at higher risk of severe infection and in greater need of glucocorticoid medication than women who discontinued biologic treatment. Flare-ups were still consistently observed in some of the women who discontinued biologic treatment (4).

Certain biologics, such as methotrexate and thalidomide, should be discontinued during pregnancy because of the risk they pose to a growing fetus. Others, such as certain corticosteroids, ozanimod, and upadacitinib, may also be interrupted because of limited experience with their use. However, anti-inflammatory agents and aspirin may be safely used during both pregnancy and breastfeeding. The choice of biologics, such as mesalamine, can also vary depending on what other agents they are combined with (5).

How Do Autoimmune Diseases Affect Fertility and Pregnancy?

Autoimmune diseases may affect fertility in multiple ways. Lupus, thyroiditis, and celiac disease may cause infertility, the complete inability to become pregnant. Others, such as rheumatoid arthritis, probably contribute more to subfertility, defined as a difficulty or delay in becoming pregnant (6).

Other autoimmune diseases may not interfere with fertility as much. Uma Mahadevan, MD, an expert in pregnancy and irritable bowel syndrome (IBD) at the University of California, San Francisco, recently highlighted the misconception that patients with IBD may have to deal with fertility problems. She added that infertility rates observed in patients with IBD are similar to infertility rates in other women (5).

In addition to potential fertility problems, pregnant women with autoimmune diseases may also be at higher risk of complications, such as recurrent pregnancy loss (7).

Because of the complex and unpredictable nature of these mechanisms, pregnant patients who have an autoimmune disease should receive guidance from collaborating specialists in clinics and institutions that offer personalized care. This support will help them make informed decisions, ensuring the well-being of both mothers and newborns. (2, 5).

Are There Long-Term Health Effects of Having an Autoimmune Disease During Pregnancy?

Having an autoimmune disease during pregnancy may also be linked to several long-term effects and complications. Blood clots, preeclampsia, placental problems, restricted fetal growth, premature birth, and even disease later in a child’s life, including cardiovascular, metabolic, and even mental disorders, have been reported for diseases such as lupus, antiphospholipid syndrome, type 1 diabetes, and rheumatoid arthritis (2, 8, 9).

A 2024 study revealed a potential two-way association between autoimmune diseases, such as multiple sclerosis, and depression in women during the perinatal period. The depression was not attributed to pre-existing mental conditions, leading researchers to propose that shared biologic mechanisms may be involved in autoimmune diseases’ association with perinatal depression (10).

How Should Autoimmune Disease Be Managed During Pregnancy?

Pregnant women with autoimmune diseases require close monitoring and care provided by collaborating specialists. Healthcare providers should consistently offer comprehensive care and support throughout pregnancy, with every woman having access to personalized care that extends beyond childbirth to ensure the health of both mother and child.

Effective strategies for managing autoimmune diseases include maintaining safe and stable medication courses, fostering open communication among various specialists, offering counseling services during pregnancy and breastfeeding, and monitoring for possible mental disorders from childhood to adulthood (2, 9, 11).

If you are pregnant or plan to start a family, talk to your doctor about any worries you may have and discuss the best ways to manage your autoimmune condition.

About The Author

A freelance writer who specializes in medical and life science topics. As a trained researcher, she authored journal articles in the areas of infection and immunity and wrote booklets and book chapters about different diseases. As a professional communicator, she writes feature articles for magazines and other publications and develops content for higher education platforms. Damiana is also an experienced academic editor, microbiology educator, writing coach, and fragrance blogger. She is a contributing member of the American Medical Writers Association and a past-president of the association’s Southwest Chapter.

Damiana Chiavolini, MS, PhD Freelance Writer for GAI

Carolyn Serraino

See Full Bio