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Autoimmune Disorders and Pregnancy

Lupus and Pregnancy, Rheumatoid Arthritis and Pregnancy, Menopause Center of Los AngelesAn autoimmune disorder is a condition in which the body’s immune system, normally designed to fight off harmful invaders, attacks healthy cells. There are many ways that a pregnancy can interact with autoimmune disorders.

  • Pregnancy may trigger an autoimmune disorder.
  • An existing autoimmune disorder can impact a pregnancy and cause harm to the fetus.
  • The antibodies that the mother produces can enter the fetus through the placenta, affecting its growth. 

Lupus and Pregnancy

It’s very difficult to predict what effect lupus (systemic lupus erythematosus) will have on a pregnancy. There have been cases where lupus worsens with pregnancy and cases where it becomes less severe. Some women will develop lupus for the first time while pregnant. Although there is a lot of variability, we do know that lupus flare-ups are more likely to occur immediately after giving birth.

Many women who suffer from lupus have a history of miscarriages, intrauterine growth restriction (IUGR), and preterm birth. As a result of their lupus, many women have also sustained kidney damage, which can increase risk for the fetus. If you have lupus, it might be best to wait for pregnancy until:

  • Your disorder has been inactive for half a year
  • Your disorder is under control with the help of medication
  • Your blood pressure is normal and your kidneys are functioning normally

When you are pregnant with lupus, you run the risk of lupus antibodies crossing the placenta and affecting your baby. The fetus may develop complications such as:

  • Slow heart rate
  • Low platelet count
  • Low white blood cell count
  • Anemia

Generally, the antibodies slowly disappear and the baby’s symptoms clear up after birth. You can continue taking hydroxychloroquine during pregnancy, and if you experience a flare-up, you can take a low dosage of prednisone, methylprednisolone, or an immunosuppressant under the instruction and care of your physician.

Antiphospholipid Syndrome

This disorder causes excessive clotting of the blood. It increases the mother’s risk of developing hypertension (high blood pressure) and preeclampsia, and increases the baby’s risk of IUGR, miscarriage, and stillbirth.

A pregnant patient with antiphospholipid syndrome can typically be treated with low-dose aspirin and anticoagulants throughout the pregnancy until about six weeks after childbirth. This can decrease the amount of clotting as well as the risk of complications.

Rheumatoid Arthritis and Pregnancy

In some cases, a woman can develop rheumatoid arthritis during pregnancy or in the weeks following delivery. Luckily, rheumatoid arthritis does not affect the fetus, but it can cause some discomfort and pain for the mother. If the lower spine or hip joints have been affected, this can make delivery more challenging.

If you already have rheumatoid arthritis, your symptoms may become less severe during pregnancy, only to return to their previous severity after birth.

Flare-ups can be treated during pregnancy with prednisone, which is a corticosteroid.

Immune Thrombocytopenia (ITP)

ITP is a tricky condition to treat in pregnant women. ITP causes the body to release antibodies that decrease the number of platelets in the blood. Platelets are the component of blood that enables clotting.  When they are in very low supply, both the mother and child may suffer from excessive bleeding.

A doctor may prescribe prednisone to increase the mother’s platelet count, but this is only effective in the long term for about half of patients. Prednisone also increases the risk of some fetal complications.

In some cases, doctors can reduce the risk of hemorrhage during birth by giving a high dose of immune globulin through an IV right before delivering the baby. This can help control the bleeding during vaginal birth.

A platelet transfusion is usually only necessary during a Cesarean section, and only if the platelet count is dangerously low.

Myasthenia Gravis

Myasthenia gravis, which causes weakness in the muscles, thankfully does not come with many risks of complication during pregnancy. However, treating the disorder may require higher doses of prescription drugs or adding a new prescription to the treatment regimen, like corticosteroids or immunosuppressants.

Some drugs that are a regular part of prenatal care, like oxytocin and magnesium, can aggravate the symptoms of myasthenia gravis. Be sure to let your doctor know your medical history before starting these drugs. In very rare cases, pregnant women with myasthenia gravis will have difficulty breathing and might require assisted ventilation.

In about one out of every five cases, the antibodies produced by the mother cross the placenta and cause the disorder in the baby. Fortunately, this is usually a temporary condition since the mother’s antibodies will gradually leave the baby once it’s outside its mother. The baby’s body would not naturally produce those antibodies.

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