Pregnancy Loss and Autoimmune Diseases
Pregnancy loss and infertility are one of the most sensitive topics we talk about and see in our clinic. While little is known about why most pregnancy loss happens, approximately 26% of all pregnancies end in miscarriage. That means that 1 in 4 pregnancies will have a spontaneous loss that is likely of an unknown cause.
The reason that we do not know much about why pregnancy loss occurs is because not many studies are done on pregnant women. Most pregnant women are protected in research, but also, pregnant women are less likely to volunteer for research studies. What we can study though is correlation. And one of the more common correlations we see is between pregnancy loss and autoimmune diseases.
How Pregnancy Affects Autoimmune Diseases
One thing we know is that autoimmune diseases occur most often in women. And pregnancy most commonly occurs in women. So it is not a surprise that autoimmune diseases can occur in many pregnant women. From this, we know a lot about how being pregnant can affect autoimmune diseases.
Women that have been diagnosed with autoimmune diseases prior to becoming pregnant will often see an improvement in their autoimmune disease due to progesterone’s effect on the immune system. Often, women who do not have an autoimmune disease prior to becoming pregnant can often develop one after birth during postpartum hormone changes.
But what is the effect of autoimmune diseases on the pregnancy itself?
How Autoimmune Diseases Affect Pregnancy
It’s been hypothesized that adverse pregnancy outcomes are associated with autoimmune conditions such as rheumatoid arthritis and lupus.
Some studies have shown that women with rheumatoid arthritis tend to have higher levels of spontaneous abortion but not stillbirth than other populations. Others have shown that unless rheumatoid arthritis have an active disease process prior to becoming pregnant, they will not increase the risk of adverse events.
For lupus, approximately 53% of those with active disease when they become pregnant will have complications during the term of their pregnancy. 16% of those pregnancies will end in loss. Anti-phospholipid antibodies present when a woman becomes pregnant increases the likelihood of complications, as does increased disease activity and the use of steroids.
Some of the theories around why this happens include cross reactivity between the fetal DNA and the mother’s DNA that make it inhospitable for fetal life. Some theories are that infections in pregnant women tend to be higher in those with autoimmune diseases, which may stimulate an inflammatory response that is detrimental to maintaining pregnancies. In those with anti-phospholipid antibodies, poor outcomes are likely related to issues with placental development and uterine growth restriction.
What Does This Mean?
While we are still uncertain about how autoimmune diseases affect pregnancy, some things are clear. For those that have had multiple miscarriages, or other pregnancy losses, or have difficulty with conceiving, a full work up for underlying autoimmune diseases should be done. Additionally, if a person with a known autoimmune disease such as rheumatoid arthritis or lupus gets pregnant, care should be taken while they are pregnant to monitor for inflammation. Keeping inflammation low and monitoring for disease activity during pregnancy is important and should be done by a Rheumatologist, PCP or OB.
In addition, pregnancy loss affects a large percentage of women worldwide. It is not only physically taxing, but emotionally taxing as well. Know that if you have suffered from pregnancy loss, it is not your fault, and feelings of sadness and depression during this time are normal. Looking for groups of those that have gone through pregnancy loss or infertility may help women get through the difficulties of pregnancy loss.
If you want more information on how autoimmunity may affect your pregnancy, you can contact our office today to speak with one of our knowledgeable physicians.
