Autoimmune disorders are more common in women, with incidences peaking during childbearing years. So, autoimmune disorders can occur in pregnancy. Certain disorders worsen during pregnancy, creating complications for the baby and the mother, while others improve, causing no harm. Continue reading to know more about pregnancy with autoimmune diseases and their long-term outcomes on the mother and the baby.
A properly functioning immune system fights off pathogens like viruses or bacteria. An autoimmune disease or disorder is a condition where the immune system attacks its healthy cells. There are various ways in which autoimmune disorders and pregnancy interact. In a few disorders like multiple sclerosis and Rheumatoid arthritis, pregnancy has a profound effect, like:
● It may trigger an autoimmune disease.
● It can interfere with and harm the fetus.
● The mother’s antibodies may enter the baby’s bloodstream, affecting its development and growth.
Antigens and antibodies combine to create an immune complex that circulates in the mother's blood and clogs the placenta. If the nutrients from the fetal membrane to the placenta decrease, the fetus does not grow enough.
Careful monitoring of such pregnant women is essential in the second and third trimesters for placental dysfunction, especially placental vasculitis. It is a capillary inflammation where the WBCs heal through scarring. This causes placental cell death and lessens placental function. An expectant mother with vasculitis is at a greater risk of giving birth to a baby of low weight or pre-mature delivery.
Women with an autoimmune disease should be in remission for at least six months before getting pregnant, as they are at a lower risk of flare-ups and pregnancy complications.
This is one of the common autoimmune disorders during pregnancy. Predicting the outcome of Lupus on pregnancy is difficult, as in some cases the disorder worsens in pregnancy and in others it becomes less severe. Some women also discover this condition in pregnancy for the first time.
Women who have a second-trimester stillbirth, growth restriction, recurrent abortions or preterm delivery often are diagnosed with lupus. Additionally, there can be flare-ups post-birth for the mother. Many women also have kidney damage, which endangers the fetus. If you have this condition, it is best not to get pregnant until it is-
● Under control with medication
● Inactive for more than 6 months
● Your kidney function and blood pressure are normal
If you become pregnant, there is a risk of antibodies getting into the fetus's bloodstream. This autoimmune disease’s effects on the baby include
● Anaemia
● Slow heart rate
● Low WBC and platelet count
Typically, after the antibodies clear from the baby’s blood, the symptoms also reduce. If you have lupus, you can take a low dose of an immunosuppressant after advice from your doctor.
When the body develops autoantibodies in reaction to some phospholipid-binding proteins, APS develops. This causes blood clotting and increases hypertension risks, preeclampsia, stillbirth and miscarriage. APS is a disorder that puts a pregnant woman at risk of thrombosis, which may cause fetal demise and IUGR (intrauterine growth restriction).
Some women develop RA in pregnancy or following delivery. It does not impact the baby, but causes pain, weakness, stiffness, swelling and fatigue. However, some medications used to treat RA during pregnancy may affect fetal development, so it's important to work with your healthcare provider to choose pregnancy-safe treatments. Additionally, there may be a slightly increased risk of preterm birth or low birth weight in some cases. If the hip joints or lower spine are affected, this leads to delivery challenges. If you have RA, your symptoms become less severe and return to previous levels post birth. Flare-ups during pregnancy can be treated with a corticosteroid.
It is a tricky disorder to treat in pregnancy. It causes the body to produce antibodies that reduce the number of platelets in the blood. When there is a low supply of platelets, both the child and mother are at risk of excessive bleeding.
To decrease haemorrhage risk during natural birth, a dose of immune globulin IV is administered by the doctor before delivery to control bleeding. The medication helps to increase platelet count. Platelet transfusions may be needed:
● If vaginal delivery is expected and the platelet count of the mother is less than 10,000/microL
● If C-section delivery is expected, and when the platelet count of the mother is less than 50,000/microL.
Though the IgG antiplatelet may reach the baby, it rarely causes fetal thrombocytopenia.
This disorder causes muscle weakness but does not pose any complications while pregnant. However, treating this may need high doses of immunosuppressants or corticosteroids. Some medications used during prenatal care, like magnesium and oxytocin, may lead to flare-ups of this disorder. In some rare cases, an expectant mother with this condition has breathing issues and may need assisted ventilation.
In 1 out of 5 cases, the mother’s antibodies cross the placenta and lead to myasthenia gravis in the baby. However, this is a temporary condition until the antibodies are flushed out of the system. The baby does not produce these antibodies naturally and hence is not at risk of this disorder in the long term.
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This disorder develops when the immune system mistakenly attacks its own cells, leading to the thickening of the skin and blood vessels, as well as scarring of the lungs and kidneys. Localised scleroderma impacts the connective tissue, skin, organs and tissues. Systemic scleroderma damages muscles, nerves, ligaments and tendons and may also cause high blood pressure.
Women with systemic scleroderma need more monitoring when pregnant, as it impacts many organs. They are more prone to high blood pressure, kidney problems and preterm labour. Localised scleroderma does not affect pregnancy.
In this disorder, the WBCs (white blood cells) that fight infection instead attack moisture-producing glands in the mouth and eyes. This leads to dry mouth, burning eyes, dry eyes, swallowing difficulties and swollen neck glands. It also affects the gastrointestinal system, blood vessels, central nervous system, liver, lungs, pancreas and kidneys.
There are two types of Sjögren’s syndrome: Primary Sjögren’s syndrome is not triggered by any other condition, whereas the secondary Sjögren’s syndrome is caused by Rheumatoid Arthritis, lupus or other autoimmune conditions. Pregnant women with this disorder are at a greater risk of miscarriage. Also, women with SS-A (anti-Ro) and SS-B (anti-La) autoantibodies are more at risk of giving birth to a baby with congenital heart disease.
Pregnancy risks of autoimmune disorders need close monitoring by a specialist. Healthcare providers should provide comprehensive and personalised care beyond childbirth to ensure the good health of the child and the mother. Some effective ways to monitor include treating with safe medication, counselling during pregnancy, open communication and monitoring the child.
Autoimmune disorders and pregnancy have an inconsistent and complex relationship influenced by many factors. However, it is possible to lessen the difficulties of managing this disease during pregnancy by waiting for remission before becoming pregnant, taking safe drugs and keeping a close eye on both the mother and the unborn child.
