How can autoimmune diseases affect a woman's pregnancy?

There are various ways that autoimmune diseases during pregnancy can manifest. Women with a pre-existing autoimmune disease may be considered high-risk during their pregnancy and may require more extensive care.

What are autoimmune conditions?

Autoimmune conditions affect different parts of the body and are characterised by the body mistakenly attacking itself.

What are the different types autoimmune conditions during pregnancy?

Common autoimmune conditions during pregnancy that can present risks include:

Lupus

Lupus, or systemic lupus erythematosus (SLE), during pregnancy carries a high risk. It can increase the possibility of:

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

The autoimmune disease during pregnancy can be treated through monitoring medication adjustments in order to control symptoms, as well as more prenatal checks.

Rheumatoid arthritis

Rheumatoid arthritis doesn't affect the foetus and symptoms become less severe for many pregnant women with this condition. However, some medications for rheumatoid arthritis are unsafe to take during pregnancy so changes and adjustments to medication may be required before conception. 

Antiphospholipid antibody syndrome (APS)

APS while pregnant leads to increased risks of blood clots and pulmonary embolisms during pregnancy, due to the fact that in APS antibodies mistakenly attack a type of fat known as phospholipids, and proteins that line the blood vessels. 

APS can also heighten the risk of:

• Stillbirth
• Miscarriage
• Delayed foetal growth
• Preeclampsia
• Maternal hypertension (high blood pressure)

APS during pregnancy treatment include preventative medication for blood clots like low-dose aspirin and heparin.  

Scleroderma​

Scleroderma, which causes inflammation in the body can can make the skin feel stiff and tight. This can lead to scarring on various organs leading to high blood pressure as well as issues in the nerves, muscles, joints, lung and kidneys. It can increase the risk of:

• Preterm labour
• Proteinuria, or protein in the urine, because of kidney damage
• Preeclampsia
• Kidney damage   

Scleroderma during pregnancy can be treated. This includes adjustments to medication and more prenatal care in order to monitor issues such as high blood pressure and organ damage or failure.   

Sjögren's syndrome

The risks of miscarriage and slow or irregular foetal heartbeat that causes the heart to pump blood less efficiently can manifest in Sjögren’s syndrome during pregnancy.

Treatment includes close monitoring of the foetus's heart with frequent echocardiograms.   

Other types of autoimmune diseases that can present risks in pregnancy include:

• Immune thrombocytopaenia (ITP)
• Thyroid diseases
• Hashimoto’s disease
• Graves' disease
• Type 1 diabetes

What are the common risks involved in autoimmune diseases during pregnancy?

The risks associated with autoimmune disease during pregnancy vary depending on the type of autoimmune disease. The risks that are most common include: 

• Blood clots
• Preterm delivery, which is delivery before 37 weeks of pregnancy.
• Preeclampsia, which is complication specific to pregnancy that's characterised by high blood pressure that can be life-threatening.
• Delayed foetal growth, which is also known as intrauterine growth restriction (IUGR).

Additionally, babies of women with autoimmune diseases may require additional care to ensure that harm hasn’t been caused to the foetus by antibodies related to the autoimmune condition.

Pregnancy can also trigger autoimmune disorders in women with no prior history of this type of condition. In some cases, for those already suffering from an autoimmune disease, the different trimesters of pregnancy and postpartum period can cause an improvement or worsening of the autoimmune disease’s symptoms.

How are autoimmune conditions factored into pregnancy planning?

Ideally, women with autoimmune diseases are able to achieve remission, a reduction or disappearance of their symptoms, around six months before pregnancy meaning that their symptoms are substantially reduced or disappear. This should be done in consultation with a specialist and may not be necessary for all women. 

What can be done to help manage autoimmune conditions during pregnancy?

A range of immunotherapy treatments as well as regular check-ups throughout pregnancy can help to keep mother and baby healthy and safe.