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| Autoimmunity and Pregnancy |
| Pregnancy and rheumatic disease: "by the book" or "by the doc". We provide some general recommendations on how to manage a rheumatic disease during pregnancy including (a) preconception planning to ensure no teratogenic medications on board, (b) early disclosure of pregnancy to all caregivers including the rheumatologist, family physician, obstetrician, and maternal-fetal medicine specialist, and (c) planning of safe medication use for acute flare-ups and disease suppression peripartum and postpartum. Keeling SO. (PubMed) Clin Rheumatol. 2008 Nov 6. |
| Management of Graves hyperthyroidism in pregnancy. Focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Antithyroid drug therapy of pregnant women with Graves hyperthyroidism should be balanced to control both maternal and foetal thyroid function. P. Laurberg. European Journal of Endocrinology. October 10, 2008. (Also see: Graves' Disease) |
| Fertility preservation treatment for young women with autoimmune diseases facing treatment with gonadotoxic agents. Oocyte or embryo cryopreservation should be considered for fertility preservation in young women with systemic autoimmune rheumatic diseases who face imminent gonadotoxic treatment. S. E. Elizur. Rheumatology Advance Access. July 26, 2008. |
| Vasculopathic diseases complicate pregnancy. Women with systemic sclerosis, primary pulmonary hypertension, or sickle cell disease are at increased risk for having complicated pregnancies. For this reason, these women should receive extensive counseling when considering pregnancy. Reuters. 04/14/08. |
| Reactivation of Rheumatoid Arthritis after Pregnancy is Accompanied by Increased Phagocyte and Recurring Lymphocyte Gene Activity in the Peripheral Blood. The increase in lymphocytes and related cell activation pathways indicates an important contributory role of theses cells in disease flare. It also demonstrates a suppression of the adaptive immune response during pregnancy. Thomas Haeupl. 823/68. ACR 2007. (Also see: RA) |
| Electrocardiographic (ECG) abnormalities in infants born from mothers with autoimmune diseases—a multicentre prospective study. This prospective study confirms the low occurrence of CHB in newborns from anti-Ro-positive mothers. ECG abnormalities (first degree AV block and QTc interval prolongation) are frequent in infants of mothers with autoimmune diseases, independently of maternal disease, autoantibody profile and treatment during pregnancy. Rheumatology 2007 46(8):1285-1289. |
| Pregnant women should supplement vitamin D. Pregnant women should take steps to ensure they have adequate vitamin D in their diet, or they and especially their unborn children may run the risk of developing autoimmune diseases such as diabetes and thyroid diseases. News-Medical.Net (Womens Health News). 03/07/07. (Also see: Causes of Scleroderma: Vitamin D Deficiency) |
| Sunshine could be key to getting enough Vitamin D. Vitamin D deficiency is a common complaint in prenatal diets, but simply getting a bit more sunshine during pregnancy could hold the key to boosting productions of it. Pregnant mothers are particularly liable to develop vitamin D deficiency, and so they are at increased risk of developing autoimmune diseases. Bounty News. 03/08/07. (Also see: Causes of Scleroderma: Vitamin D Deficiency) |
| Inflammatory bowel disease doubles risk of pregnancy complications. Inflammatory bowel disease (BS) roughly doubles the chances of pregnancy complications, reveals research. EurekAlert! 12/19/06. (Also see: IBD) |
| Connective tissue diseases and pregnancy. Every pregnancy in a patient with CTD should be regarded as high-risk pregnancy, and requires intensive monitoring and immediate treatment of clinical problems. PubMed. Rheumatology (Oxford). 2006 Oct;45 Suppl 3:iii30-iii32. |
| Pregnancy and Rheumatic Disease. For years, women with potentially serious systemic autoimmune diseases have been advised against getting pregnant. We now know that, with careful medical and obstetric management, most of these women can have successful pregnancies. American College of Rheumatology. July 2006. |
| Rare autoimmune rheumatic illnesses during pregnancy: systemic sclerosis, polymyositis/dermatomyositis and vasculitis. Autoimmune rheumatic diseases (ARD) affect young females durrng childbearing age. Over the last decades, improvements in survival as well as quality of life in patients affected with ARD have led to an increased number of pregnancies observed during the course of such diseases. PubMed. Z Rheumatol. 2006 May 3. (Also see:Dermatomyositis, and Vasculitis) |
| Autoimmunity, infertility and assisted reproductive technologies. It is not likely that autoimmunity causes infertility, nor that patients with autoimmune diseases are unusually infertile. When carefully monitored in selected patients, ART does not appear to harm patients who have pre-existing autoimmune diseases. Stable autoimmune diseases without major organ damage probably do not affect the outcomes of ART pregnancies. PubMed. Lupus. 2004;13(9):669-72. |
| Screening for thyroid disease in pregnancy. Postpartum thyroid dysfunction (PPTD) occurs in 5-9% of women and is associated with antithyroid peroxidase antibodies (antiTPOAb) in 10% of women in early pregnancy. Therefore, screening for thyroid dysfunction in pregnancy should be considered. PubMed. J Clin Pathol. 2005 May;58(5):449-52. (Also see: Thyroid Disease) |
| Obstetric complications due to autoantibodies. Autoimmune diseases are most common and most active in young women; it is therefore not uncommon for obstetricians and physicians to encounter pregnant women with these conditions, and knowledge of the potential maternal, foetal and neonatal complications is essential for good clinical management. PubMed. Best Pract Res Clin Endocrinol Metab. 2005 Mar;19(1):149-75. |
| Pregnancy and autoimmune diseases. Until about 15 years ago, the general advice to women with autoimmune rheumatic diseases was to avoid pregnancy as there was a high risk of maternal and fetal morbidity and mortality. However, it is now clear that these risks can be reduced in general by avoiding pregnancy when the diseases are active and continuing appropriate medication to reduce the chances of disease flare during pregnancy. PubMed. Best Pract Res Clin Rheumatol. 2004 Jun;18(3):359-79. |
| Multi-lineage potential of fetal cells in maternal tissue: a legacy in reverse. Rather than triggering disease, fetal cells may instead combat it. PubMed. J Cell Sci. 2005 Apr 15;118(Pt 8):1559-63. (Also see: Fetal Cells and Scleroderma) |
| Autoimmunity and Early Menopause |
| Causes of Early Menopause: Autoimmune Disorder. Autoimmunity is a common cause of premature ovarian failure. In fact, some recent studies have shown that up to two-thirds of the women with premature ovarian failure have it due to an autoimmune disorder. Antibodies may attack your reproductive system, and may interfere with and ultimately destroy your ovarian function. If you have a family history of autoimmune disorders or have one yourself (such as thyroid disease, diabetes, or rheumatoid arthritis), this may be the cause for your early menopause. EarlyMenopause.com. |
| Antidepressants and Fetal Pulmonary Hypertension |
| Antidepressants May Harm Infants' Lungs. Expectant mothers who took antidepressants like Prozac late in their pregnancy were significantly more likely to give birth to an infant with a rare but serious breathing problem, pulmonary hypertension. The New York Times. 02-09-06. (Also see: Pulmonary Hypertension, and Depression) |
| Preeclampsia |
| Study shows pre-eclampsia may be an autoimmune disease. Researchers from University of Texas-Houston Medical School have revealed that pregnancy-induced high blood pressure or pre-eclampsia might be an autoimmune disease. The London News.Net. July 28, 2008. |
| Successful pregnancy with the use of nitric oxide donors and heparin after recurrent severe preeclampsia in a woman with scleroderma. Nitric oxide donors and heparin may play a preventive role on placental dysfunction in scleroderma. PubMed. Am J Obstet Gynecol. 2007 Aug;197(2):e6-7. |
| High Blood Pressure in Pregnancy - Information Preeclampsia is a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure and protein in the mother's urine. Women with diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma are more likely to develop preeclampsia. Medical News Today, 13 Feb 2004. |
| Congenital Heart Block in Fetuses |
| Heart-stopping Antibodies. Autoimmune antibodies, attack the body's own cells, and those circulating in women with lupus and other autoimmune diseases can also cross the placenta and cause congenital heart block in the fetus. Scientists in Sweden now show how these antibodies cause heart cells to become paralyzed and eventually die, according to a study in the January 3rd issue of The Journal of Experimental Medicine. ScienceDaily. 01/20/05. |
| Ro/SSA autoantibodies directly bind cardiomyocytes, disturb calcium homeostasis, and mediate congenital heart block. Congenital heart block develops in fetuses after placental transfer of Ro/SSA autoantibodies from rheumatic mothers. The condition is often fatal and the majority of live-born children require a pacemaker at an early age. These findings suggest that passive transfer of maternal p200 autoantibodies causes congenital heart block by dysregulating Ca2+ homeostasis and inducing death in affected cells. JEM, Volume 201, Number 1, 11-17, 3 January 2005. (Also see: Antibodies) |
| Male Infertility |
Fertility and Reproduction in Male Patients with Ankylosing Spondylitis (AS) Treated with Infliximab. We identified 4 patients with AS who had fathered 6 healthy children during infliximab treatment. Our cases provide some evidence or reassurance for male patients treated with the anti-tumor necrosis factor-α agent. S. Paschou. J Rheumatol First Release. Dec 1 2008. (Also see: Ankylosing Spondylitis and Infliximab) |
| Lupus Treatments Increase Risk of Infertility in Men. Men with systemic lupus erythematosus, especially those who begin treatment with intravenous cyclophosphamide after puberty, are at risk for sperm abnormalities associated with infertility. Medpage Today. 06/28/07. (Also see: Lupus and Cytoxan) |
| Key to Male Infertility. A factor in immune cells regulates human semen and seems to determine whether a man will be fertile, according to a new study. Macrophage migration inhibitory factor (MIF) is key to helping sperm mature, which is necessary for its union with an egg. The finding could lead to a diagnostic test to determine fertility status. Medical News Today. 070507. |
| Medications and Pregnancy |
| Pregnancy Outcome after Exposure to Biologics: Results from the German Biologics Register RABBIT. Even though the numbers of cases are still low and final conclusions cannot be drawn, our data support the current view that exposure to biologic agents until confirmation of pregnancy does not increase the risk for congenital malformations, miscarriages or low birth weight. Anja Strangfeld. 730. ACR 2007. (Also see: DMARDs) |
| Pregnancy and rheumatic diseases. Infertility is rarely due to the disease but can be associated with cyclophosphamide therapy. Most rheumatic diseases that are well controlled prior to pregnancy do not deteriorate in pregnancy, providing that the patient continues with appropriate disease-modifying therapy. Rheumatology 2007 46(11):1634-1640. (Also see: Medications) |
| Gold Therapy in Women Planning Pregnancy: Outcomes in One Center. Our clinic experience and the published literature support the current practice that in patients with Rheumatoid Arthritis, gold may still be considered a treatment option in women planning pregnancy. J Rheumatol 2007;34:1827-31. (Also see: Rheumatoid Arthritis) |
| Therapy with Immunosuppressive Drugs and Biological Agents and Use of Contraception in Patients with Rheumatic Disease. The increasing use of combination therapies containing Methotrexate necessitates ensuring that advice regarding birth control is followed in order to avoid pregnancies exposed to potentially fetotoxic drugs. J Rheumatol 2007 June;34:1266-9. (Also see: Immunosuppressants and DMARDs) |
| ACE Inhibitors May Boost Birth Defects. The FDA is encouraging women who are taking ACE inhibitors to reconsider the use of those drugs before or during pregnancy. A study published in The New England Journal of Medicine shows a higher rate of birth defects in babies born to women who filled prescriptions for ACE inhibitors in the first trimester of pregnancy. WebMD. 06/08/06. (Also see: Hypertension Treatments) |
| Low Dose Methotrexate in the First Trimester of Pregnancy: Results of a French Collaborative Study. Although no definitive conclusion can be drawn, our results and the analysis of the literature support the conclusion that no strong teratogenic risk is associated with low dose MTX provided that the drug is discontinued as early as possible in pregnant women. J Rheumatol. December 2004;31:2360-5. (Also see: Medications) |
| Pregnancy and Scleroderma |
| This information on pregnancy applies only to systemic sclerosis (scleroderma) —such as diffuse, limited, CREST, and overlap —and not to localized forms, such as linear or morphea. |
| It is very important to consult your medical team if you are contemplating a scleroderma pregnancy, since medications may need to be adjusted beforehand, and specific risk issues can be addressed. |
| Many systemic scleroderma patients are able to successfully bear children, however it is always considered a "high risk" pregnancy and extra monitoring and precautions are necessary, both before and during pregnancy. |
| Common sense must prevail, of course. Patients with rapid onset or severe internal organ involvement may need to postpone pregnancy until the symptoms abate or toxic treatments are completed. Depending on the situation, a few people may still be advised to forego pregnancy plans altogether, or to select another route to parenthood (such as adoption or surrogate parenthood). |
| Assessment of reproductive history in systemic sclerosis. Compared with the general population, fewer live births were noted in women with SSc, but this phenomenon was only apparent in the period after symptom onset. S. Bernatsky. (PubMed) Arthritis Rheum. 2008 Oct 30;59(11):1661-1664.. |
| Pregnancy Outcome In Egyptian Scleroderma Patients. The subclinical vasculopathy occurring during and even before disease onset can explain the higher proportion of abortions, premature children and delay in conception of the SSc patients. There is an association between myositis and reduced abortion which needs further investigation including the effect of the drugs used should be considered. H.E. El-Sherif. FRI0267. EULAR 2008. (Also see; Myositis) |
| Outcome of pregnancies complicated by systemic sclerosis and mixed connective tissue disease (MCTD). Most pregnancies in women with SSc and MCTD in this cohort were uncomplicated. The high rates of prematurity and small for gestational age infants underscore the risk for growth restriction consistent with the vasculopathy associated with these diseases. (PubMed) Lupus, Vol 15, No 9, Sept 2006, pp. 595-599(5). (Also see: MCTD) |
| Scleroderma and repeated spontaneous abortions treated with vitamin E--a case report--. A 33-year-old woman was referred to a hospital due to repeated spontaneous abortions and positive autoantibodies. Tocopherol nicotinate was administered. Five months after the initiation of the treatment, she became pregnant and later delivered a healthy baby. PubMed. Kurume Med J. 2005;52(3):93-5. |
| Reproductive Health in Patients with Scleroderma. This study showed impaired fertility before disease onset in women with scleroderma compared to healthy women. This finding is not partly explained by the higher rate of miscarriage. M. Micu. FRI0134 EULAR 2005. |
| Childbearing and the Risk of Scleroderma: A Population-based Study in Sweden. The association between lower parity and increased risk of scleroderma could reflect subfecundity caused by scleroderma before disease became clinically evident, possible common causes of infertility and scleroderma, or a protective effect of pregnancy through an unknown mechanism. PubMed. Am J Epidemiol. 2004 Jan 15;159(2):162-6. |
| Evidence that Pregnancy Specific Glycoproteins Regulate T-Cell Function and Inflammatory Autoimmune Disease During Pregnancy. The capacity of the pregnancy state to regulate T-cell function is well documented. A consequence of this regulation is that many T-cell mediated autoimmune disorders, including multiple sclerosis (MS) are suppressed during pregnancy. The regulation of T-cell function during pregnancy is likely the result of significant hormonal changes and may well involve immunoregulatory proteins derived from the placenta. PubMed. Curr Drug Targets Inflamm Allergy. 2005 Apr;4(2):231-7. (Also see: Multiple Sclerosis and Causes of Scleroderma: T Cells) |
| Histopathological changes of cervical tissue in women with systemic sclerosis. It was concluded that the problems that are seen in common obstetric and gynecological practices in patients with systemic sclerosis may be explained by these tissue abnormalities. PubMed. Pathol Int. 2004 Oct;54(10):759-64. |
| Pregnancy, microchimerism and autoimmunity: an update. To assess the possible relationship between pregnancy and the incidence of systemic sclerosis we performed a hospital-based case-control study. Our results, indicating a reduced risk for systemic sclerosis in women who had been pregnant in comparison with women who had not, seem to indicate that pregnancy is not a risk factor for systemic sclerosis. PubMed. Lupus. 2004;13(9):659-60. (Also see: Fetal Cells and Scleroderma) |
| Slide Show: Pregnancy and Scleroderma |
| Scleroderma and Pregnancy an online slide show by Asim Iqbal, MD, Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan. (Also see: ISN: Dr. Iqbal and "Case of the Unfortunate Fetus" in Voices of Scleroderma Volume 1 book.) |
| Smoking and Pregnancy |
| Smoking poses increased dangers for systemic scleroderma patients, since they are also prone to many types of lung involvement. Smoking also worsens Raynaud's, often leading to digital ulcers, gangrene, and amputation. |
| Smokers With Systemic Sclerosis Risk Severe Digital Vascular Complications. Patients with systemic sclerosis (SSc) who smoke are three to four times more likely than are never-smokers to incur digital vascular complications, researchers in England have found. Doctor's Guide. 1/24/03 Arthritis & Rheumatism 2002;46:12:3312-3316. (Also see: Digital Ulcers) |
| Personal Stories: Pregnancy and Scleroderma |
| Anna: Linear Scleroderma (Poland) I realised that it is not worthwhile to give up, even during the most difficult moments; it is necessary to fight and to believe that it will be better. If I had not believed I would not have been alive now... |
| Barbs: Systemic Sclerosis, CREST, Raynaud's So from the outset, diagnosis took 20 years... |
| Buggzy: Autoimmune Hepatitis, Fibromyalgia, Undiagnosed I am really desperate to get some answers or to hear from others in the same boat as me... |
| Becky H: CREST Scleroderma I am interested in becoming a pen pal with someone so that we can be supportive to each other as changes occur and compare notes... |
| Cara: Morphea Scleroderma I recently saw a rheumatologist who says it's limited or localized scleroderma... |
| Dienne: Morphea plus possible CREST I finally saw a rheumatologist about 6 years ago, who told me I had Raynaud's and Telangiectasia (spider veins)... |
| Fred: Future Spouse of Scleroderma Patient I met a girl five months ago and immediately fell deeply in love with her... |
| Gerald: Spouse of Scleroderma Patient She would often comment how she wished they could figure out what was wrong, give her the pill to fix it, and she would feel fine again... |
| Gertie: Systemic Scleroderma without Skin Involvement or Raynaud's She looked thoughtful for a moment, then quietly asked "Is there hope?" |
| Gina: Morphea or Linear Scleroderma I really try to put it out of my mind and be thankful that it is not systemic... |
| Jill: CREST Scleroderma and Sjögren's I could not face being in or visiting a hospital so I discharged myself from his care. I decided that I have lived with it this long so will simply get on with it again... |
| Kath: Systemic Sclerosis (Scleroderma) Moving to Spain has had a positive effect on my Raynaud's, but has had no effect, so far as I am aware, on my scleroderma... |
| Kathy R: Localized Scleroderma I was diagnosed with Localized Scleroderma when I was six months pregnant with my son in 1965. It started at the time with blotches on my right arm... |
| Lee: Undifferentiated Connective Tissue Disease (UCTD) A Sloan-Kettering researcher said our problems were related to HLA-B27 inheritance... |
| Lisa P: Undifferentiated Connective Tissue Disease (UCTD) I have an appointment with a new rheumatologist on May tenth. Hopefully I will get some answers... |
| Lorrie: Limited Scleroderma/CREST At first I thought, "Oh my goodness! I am going to die." But my doctor assured me that I could very likely live to be an old woman... |
| Lynn S: Diffuse Scleroderma and Pulmonary Hypertension No one believed me; I guess because I look healthy. I would always hear, 'You are too young for this!' It is hard for people to understand... |
| Marina: Diffuse Scleroderma I was sent to a rheumatologist who spent one and a half hours checking me while explaining this rare and incurable autoimmune connective tissue disease in a nut shell... |
| Naomi: Systemic Sclerosis and Pulmonary Fibrosis My doctor is astonished of my attitude considering I have Raynaud's, my fingers are curling up and I have lost my nails, pulmonary fibrosis... |
| Nathalie: Lupus/Scleroderma I arrived at the hospital with two black fingers. They had gangrene and I was very worried about having an amputation... |
| Patricia M: Morphea My breasts looked as if they were on fire... |
| Patti: Generalized Morphea I have patches all over my body, including my hands and feet and something brewing on my face... |
| Robin: Difficult Diagnosis My rheumatologist said I have scleroderma, but just lately she said now she is not sure if it is that or fibromyalgia... |
| Seema: Progressive Systemic Sclerosis (India) My real woes started in January 2002. I developed severe arthritis. My fingers got swollen and my knee joints became inflamed... |
| Silezia: Mixed Connective Tissue Disease (South Africa) I believe that if we try to feel positive about our life and the cards we are dealt, then we can manage our disease most effectively... |
| Sparky: Diffuse Scleroderma My pulmonary disease worsened only slightly over the past year. I now face the decision to take cytoxan... |
| Sue "SASA": Morphea Scleroderma I am a thirty-eight-year-old woman living in South Australia, where there is a high incidence of morphea... |
| Takeya: Morphea Scleroderma I thank God that it's not harmful to me or the baby... |
| Veronica: Sjögren's Syndrome (Italy) I am a 30-year-old woman and I have been suffering for three years from Sjögren's Syndrome with highly positive anti-SSA antibodies... |
| Related Information |
| Causes of Scleroderma: Genetics ISN. |
| Voices of Scleroderma Volume 1 book features an article, "The Case of the Misfortunate Fetus" by Asim Iqbal, MD, Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan. |
