Autoimmune Disease and Pregnancy
Autoimmune diseases disproportionately affect women, often during their prime reproductive years. Consequently, understanding their interplay with pregnancy is crucial for optimizing maternal and fetal health. A recent study, “Autoimmunity in obstetrics and autoimmune diseases in pregnancy,” delves into this complex relationship.
Here’s what the article found:
Systemic Lupus Erythematosus (SLE), a systemic autoimmune disorder, poses significant pregnancy risks. Pre-pregnancy planning is essential for mitigating complications, especially for women with recent disease activity or specific SLE subtypes. Treatment strategies vary based on disease severity and pregnancy trimester.
Potential adverse outcomes:
- miscarriage
- growth restrictions
- preterm birth
- hypertensive disorders
- fetal loss
- neonatal lupus
Antiphospholipid Syndrome (APS), characterized by abnormal blood clotting, heightens the risk of miscarriage. The presence of specific antibodies can be a marker for poor pregnancy outcomes. Preconception care is vital to support placental health and reduce pregnancy complications.
Predictors of complications:
- presence of SLE or another autoimmune disease
- previous pregnancy loss
- specific autoantibodies
- blood clotting abnormalities
Low-dose immunotherapy and anticoagulants, combined with Doppler ultrasound monitoring, are essential during pregnancy.
Sjögren’s Syndrome (SS), an autoimmune disorder that targets moisture-producing glands, is increasingly prevalent among pregnant women. The most severe pregnancy-related complication is congenital heart block (CHB), caused by maternal autoantibodies attacking the fetal heart. Risk factors of CHB include maternal autoantibodies, family history, and female fetus.
Fetal echocardiograms and specific medications can manage CHB, but many affected children will require pacemakers. The overall impact of SS on pregnancy remains unclear and requires further research.
Rheumatoid Arthritis (RA), an inflammatory joint disease, improves in 60% of pregnancies. However, flares can occur postpartum.
Medication adjustments are necessary throughout pregnancy due to drug contraindications. Preconception planning is crucial for optimal management.
Systemic Sclerosis (SSc), a multi-organ targeting autoimmune disease, is less understood in pregnancy. While previously discouraged, recent evidence suggests more favorable outcomes for pregnant women with SSc. However, research is needed to clarify pregnancy complications and outcomes in this population.
Autoimmune diseases present unique challenges during pregnancy. Early and comprehensive care, including preconception planning, is vital for optimizing maternal and fetal well-being. Further research is necessary to deepen our understanding of these complex interactions and develop targeted interventions.
Citation:
De Carolis, S., at al. (2019). Autoimmunity in obstetrics and autoimmune diseases in pregnancy. Best practice & research. Clinical obstetrics & gynaecology, 60, 66–76. https://doi.org/10.1016/j.bpobgyn.2019.03.003