Pregnancy Risk Factors: Autoimmune Diseases

Antiphospholipid antibody syndrome (APS) during pregnancy

APS is a rare autoimmune disease in which antibodies mistakenly attack a type of fat, called phospholipids, and proteins that line the blood vessels, putting mothers at an increased risk of blood clots and pulmonary embolisms during pregnancy.

APS also increases the risk of:

• Maternal hypertension (high blood pressure)
  
  
• Preeclampsia
  
  
• Delayed fetal growth
  
  
• Miscarriage (loss of a fetus before 20 weeks of pregnancy)
  
  
• Stillbirth (loss of a fetus after 20 weeks of pregnancy)

Treatment for APS during pregnancy includes medications to help prevent blood clots, such as low-dose aspirin, as well as other anticoagulants, like heparin.

Scleroderma during pregnancy

Scleroderma is an autoimmune disease that commonly affects the skin and other bodily organs. It causes inflammation in the body, which can make the skin feel stiff and tight and cause scarring on various organs, leading to high blood pressure as well as nerve, muscle, joint, lung and kidney issues.

Scleroderma increases the risk of:

• Preeclampsia
  
  
• Kidney damage
  
  
• Proteinuria (protein in the urine due to kidney damage)
  
  
• Preterm labor

Treatment for scleroderma during pregnancy includes medication adjustments and more frequent prenatal care to monitor you and your baby and prevent/treat issues such as high blood pressure and organ damage or failure.

Systemic lupus erythematosus (SLE) during pregnancy

SLE, commonly known as lupus, is one of the higher-risk autoimmune diseases during pregnancy in which a woman’s immune system attacks healthy tissue within her body and causes inflammation. Lupus can affect a wide range of areas in the body, including the vascular system, brain, lungs, kidneys, joints and skin. Symptoms may include fatigue, joint pain, fever and rashes.

Lupus increases the risk of:

• Preeclampsia
  
  
• Maternal nephritis or kidney damage
  
  
• Fetal cardiac complications, including slow heart rate and arrhythmias (irregular heartbeat)
  
  
• Anemia (low red blood cell count) in the fetus
  
  
• Delayed fetal growth
  
  
• Miscarriage
  
  
• Preterm birth
  
  
• Stillbirth

Treatment for lupus during pregnancy includes medication monitoring/adjustments to control your symptoms as well as more frequent prenatal care and monitoring. So, make sure you attend all of your scheduled OB-GYN appointments.

Despite the risks, women with lupus often have good pregnancy outcomes if they can achieve remission before getting pregnant.

Sjogren’s syndrome during pregnancy

Sjogren’s syndrome is an autoimmune disease that attacks moisture-producing glands in the body, in areas such as the eyes and mouth, leading to issues like a painful, burning sensation in the eyes, dry mouth, swollen neck glands and vaginal dryness. If it progresses, Sjogren’s syndrome can also damage the kidneys, lungs, thyroid, liver and nervous system.

Sjogren’s syndrome increases the risk of:

• Miscarriage
  
  
• Fetal heart block (slow or irregular fetal heartbeat that causes the heart to pump blood less efficiently)

Treatment for Sjogren’s syndrome during pregnancy includes close monitoring of the fetus’s heart with frequent echocardiograms (ultrasounds that show detailed images of the heart).

Immune thrombocytopenia (ITP) during pregnancy

ITP is an autoimmune disease that causes a decrease in the number of platelets in the blood, which can lead to excessive bleeding in the mother as well as the fetus. Unfortunately, this condition tends to get worse during pregnancy.

Treatment for ITP during pregnancy includes steroid medications, such as prednisone, to increase platelets. However, prednisone has only been shown to be effective in about 50 percent of pregnant women and may put the fetus at an increased risk for certain complications.

Your OB-GYN may administer a medication called immune globulin immediately before a vaginal delivery to reduce your risk of bleeding during delivery.

Rheumatoid arthritis (RA) during pregnancy

Rheumatoid arthritis is an autoimmune disease that causes inflammation in the joints, resulting in pain, stiffness and swelling.

The good news is that RA does not affect the fetus, and in about 50 percent of mothers, symptoms of RA become less severe during pregnancy. Some RA medications are unsafe to take during pregnancy, so medication changes and adjustments may be needed before conception.