Pregnancy and Autoimmune Disorders

Lupus and Pregnancy, Rheumatoid Arthritis and Pregnancy, Thais Aliabadi, f Los Angeles OBGYN A healthy, normally-functioning immune system is designed to fight off harmful invaders, like bacteria or viruses. An autoimmune disorder is a condition in which the body’s immune system attacks your own healthy cells. There are many ways that pregnancy and autoimmune disorders can interact.

Pregnancy may trigger an autoimmune disorder.
An existing autoimmune disorder can interfere with pregnancy, causing harm to the fetus.
The antibodies that the mother produces can enter the fetus’s system, 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 other cases where the condition becomes less severe. Some women will develop lupus for the first time while pregnant.

Although there is a lot of variability, one thing we do know is that lupus flare-ups are more likely to occur immediately after giving birth.

Many lupus patients 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 to get pregnant until:

Your disorder has been inactive for 6 months or more.
Your disorder is under control with the help of medication
Your blood pressure and kidney function are both normal.

If you get pregnant, 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 will 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

Some women may develop rheumatoid arthritis during pregnancy, or in the weeks following delivery. Rheumatoid arthritis will not affect the fetus, but it can cause pain, stiffness, weakness, fatigue, and swelling 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, 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 enable clotting. When they are in 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.

To reduce the risk of hemorrhage during vaginal birth, your doctor can administer a high dose of immune globulin through an IV right before delivery. This can help control the bleeding.

A platelet transfusion is usually only needed during a Cesarean delivery, 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 have difficulty breathing, and require assisted ventilation.

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