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Autoimmune Disorders and Pregnancy

Katlyn Joy | 2, June 2014


Our immune systems are supposed to protect us from germs and other threats from outside the body. However, when you have an autoimmune disorder, that system develops a glitch where the body confuses itself with outside threats and makes autoantibodies that attack normal, healthy cells. There are 80 known autoimmune disorders.

Autoimmune disorders are most prevalent in women of childbearing age, so pregnancy and autoimmune disorders go hand in hand. These disorders affect 23.5 million Americans, and are a leading cause of death and disability, according to the Office on Women's Health, which is a division of the U.S. Department of Health and Human Services.

Some of these disorders are rather common, while others are quite rare. Fertility and pregnancy can be affected by disorders affecting the immune system, but how and how severely depends on the condition and the individual.

Planning a Pregnancy with an Autoimmune Disorder

Since your illness may impact your pregnancy, and even your attempts to conceive, once you've decided it's time to start a family, or add to it, you should make an appointment with your doctor. If you have various specialists, as many people with autoimmune diseases do, you should bring them all onboard to hear their advice and concerns.

With certain conditions, pregnancy is known to be fairly smooth and medications safe. This is not true with all autoimmune disorders, though. Your doctor may recommend you wait to get pregnant until you are in a period of remission from your illness. You may need to take some special steps to ensure you are in your best possible health before trying to conceive.

Taking care of yourself is always important for any woman planning a pregnancy, but the stakes are higher if you have a chronic illness. You need to safeguard your health with exercise, a healthy diet, regular good sleep, and lowered stress.

For years it was suspected that having a baby raises a woman's chances of developing an autoimmune disorder. A large study involving a million women in Denmark between 1962 and 1992 looked at this question. The answer: in the first year after giving birth, a woman's risk of developing an autoimmune disorder increases by 15 percent if vaginal delivery, and 30 percent if a c-section.

For women who already have a disorder, pregnancy may alter her illness. She may become more compromised, she may go into remission or there may be no discernible difference. However, there are some general patterns for the more common illnesses.

Rheumatoid arthritis.

This condition often appears after childbirth, but for those with the disease while pregnant, symptoms may disappear while expecting a baby. The baby seems unaffected, but should a woman's hips or lumbar spine be affected greatly by her illness, delivery may be affected. If a woman should have a flare, she will typically be given prednisone as first treatment.

Systemic Lupus Erythematosus (SLE).

Lupus sometimes manifests in problems in pregnancy prior to diagnosis, leading to second trimester stillbirths, preterm births, recurrent miscarriages or a baby with fetal growth problems. For a woman with SLE, the best option is to get pregnant after six months of no flares, with medications changed in advance to prepare, and with normal blood pressure and renal function. SLE has varied courses in pregnancy, but can increase severity of symptoms. Pregnancies will require careful monitoring, and the baby can have problems at birth, but those usually resolve after the mother's antibodies are gone from the infant's system. These pregnancies need especially to be watched for prematurity and preeclampsia.

Myasthenia Gravis.

Myasthenia gravis varies a great deal among pregnancies. For many women, medications must be changed or doses increased. This may cause side effects such as diarrhea, vomiting, abdominal pain and fatigue. Women have to be monitored closely during labor, and anything that may affect respiration requires extra vigilance. Some women will need assisted ventilation as well.

Antiphospholipid syndrome.

This illness may cause pregnancy-induced hypertension, preeclampsia, intrauterine growth restriction and even fetal death. Women with this disorder are usually treated prior to pregnancy with anticoagulants, and during pregnancy and post-delivery are given low-dose aspirin.

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