The immune system protects us from disease and infection by defecting the germs that get into our body like viruses and bacteria. The immune system informs that the germs aren’t part of the body so it starts destroying them. In the case of people with autoimmune disease, their immune system attacks the healthy cells of organs and tissues by mistake. Pregnancy with autoimmune disorders is a double jeopardy situation where the mother and fetus both are at risk.
Autoimmune disease can affect any part of our body. These are diseases like alopecia areata causes hair loss. Autoimmune hepatitis affects the liver. In the case of type 1 diabetes, the immune system attacks the pancreas. This is the organ that releases the hormone insulin to control our blood sugar levels. In addition, the immune system can attack many parts of the body like the joints, lungs, and eyes. Patients with rheumatoid arthritis are the ones to get affected by the joint lesions.
Autoimmune diseases in relation to pregnancy:
Autoimmune disorders are conditions where the self-directed immune response results in clinical manifestations. Women in the past year with autoimmune diseases were encouraged not to conceive. But, women in today’s world with many autoimmune conditions are enjoying healthy pregnancies. However, they are still at high risk.
Autoimmune disorders are more common among women and tend to rise after puberty. Thus, these disorders occur in pregnant women.
Pregnancy with autoimmune disorders are more complex situations in many ways. In fact, pregnancy plays a major role in modifying disease course. It can adversely affect autoimmune diseases like Rheumatoid arthritis and multiple sclerosis.
What can happen during pregnancy with autoimmune disorders?
- Pregnancy may trigger an autoimmune disorder in the women.
- An existing autoimmune disorder can interfere with pregnancy, which is harmful to a fetus.
- The antibodies that the mother produces can enter the foetal system, affecting growth.
Antibodies and antigens together form a floating immune complex, which circulates in maternal blood, obstructing the filter of the placenta, and causing it to become partially blocked. If the number of nutrients crossing the fetal membrane decreases, the baby will become smaller. Those patients especially in the late second and third trimesters for early placental dysfunction. The problem starts when a woman develops placental vasculitis. Women with vasculitis are at risk of preterm delivery and small-for-age babies.
In these cases, women should achieve remission, that is their symptoms disappear or substantially improve, for at least six months before pregnancy. Women whose autoimmune conditions are in remission state have a reduced risk of pregnancy complications and symptom flare-ups.
The doctors can adjust medications and monitor the symptoms to help you achieve this goal.
There are several cases where lupus worsens pregnancy and other cases where the condition becomes less severe. Some women will develop lupus symptoms for the first time while pregnant.
Systemic lupus erythematosus (SLE) makes its first appearance during pregnancy. Women who with a 2nd-trimester unexplained stillbirth are the suspects. They can also have growth restriction, preterm delivery, or recurrent spontaneous abortions.
Women with lupus might be best to wait to get pregnant until the disorder has been inactive for 6 months or more, or under control with the help of medication and normal blood pressure and kidney function.
Antiphospholipid Antibody Syndrome (APS) and pregnancy:
Antiphospholipid Antibody Syndrome causes huge clotting of the blood. It increases the mother’s risk of developing hypertension and increases the baby’s risk of IUGR, miscarriage, and stillbirth.
A pregnant patient with the antiphospholipid syndrome can be treated with low-dose aspirin and anticoagulants throughout the pregnancy, until about six weeks after childbirth which can decrease clotting as well as the risk of complications.
APS is caused by autoantibodies to certain phospholipid-binding proteins that would protect against excessive coagulation activation.
Rheumatoid Arthritis and Pregnancy
Women develop rheumatoid arthritis during pregnancy, or in the weeks following delivering baby. Rheumatoid arthritis does not affect the growing fetus. However, it causes pain, stiffness, weakness, fatigue, and swelling for the mother. With the lower spine or hip joints disease, childbirth becomes difficult.
If someone already have rheumatoid arthritis, their symptoms may become less severe during pregnancy, and return to their previous severity after birth.
Immune Thrombocytopenia (ITP) and pregnancy:
Immune thrombocytopenia mediated by maternal antiplatelet IgG tends to worsen during pregnancy which increases the risk of maternal morbidity
ITP is a difficult condition to treat pregnant women. ITP causes the body to release antibodies that decrease platelets in the blood. Platelets are the component of blood that performs clotting. When they are in low state, both the mother and child may suffer from excessive bleeding.
Sjogren’s Syndrome and Pregnancy:
Primary Sjogren’s syndrome occurs on its own and not triggered by another condition. Secondary Sjogren’s syndrome develops in women who has another autoimmune condition like rheumatoid arthritis or lupus.
Some pregnant women presenting with Sjogren’s syndrome have a higher risk of miscarriage. Women with Sjogren’s syndrome who have anti-Ro (SS-A) or anti-La (SS-B) autoantibodies in the blood that mistakenly attack the body’s own tissue are at a higher risk of having a baby born with congenital heart block, in which the baby’s heart becomes scarred and beats more slowly.
Pregnancy with autoimmune disorders and medications
Medications given for autoimmune conditions in pregnant patient may be in lower doses. The potent anti-inflammatory medications prescribed at the lowest dose during pregnancy decrease a woman’s risk of developing pregnancy complications. Steroids is not advised to be given on a chronic basis in high doses before 16 weeks’ gestation because they cause congenital anomalies.