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| Autoimmunity and Pregnancy |
| Association of Family History of Autoimmune Diseases (AD) and Autism Spectrum Disorders (ASD). Associations regarding family history of type 1 diabetes and infantile autism and maternal history of rheumatoid arthritis and ASDs were confirmed from previous studies. A significant association between maternal history of celiac disease and ASDs was observed for the first time. H. Atladóttir. Pediatrics. Vol. 124 No. 2 August 2009, pp. 687-694. |
| Reproductive Factors and Risk of Systemic Lupus Erythematosus (SLE): Nationwide Cohort Study in Denmark. Nulliparous women, 1-child mothers, and women who experience spontaneous abortions, missed abortions, or stillbirths are at increased SLE risk. C.J. Ulff-Moller. JRheum. June 30 2009. |
| Increased risk of adverse pregnancy outcomes in women with Rheumatoid Arthritis (RA): a nationwide population-based study. Women with RA had increased risk of low birthweight, small for gestational age babies, preeclampsia, and cesarean section, compared with unaffected women. H. Ching Lin. Ann Rheum Dis. April 29 2009. (Also see: Rheumatoid Arthritis) |
| 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. |
| 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. |
| 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: Rheumatoid Arthritis) |
| 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) |
| Autoimmunity and Early Menopause |
| Gynecologic and Obstetric History IN Systemic Sclerosis (SSC) PATIENTS IN Spain: A Case Control Study. SSc patients, especially those with diffuse disease or aScl70 antibodies, are less often ever pregnant and have less intention to become pregnant than healthy controls. These is confirmed for patients with disease onset before 35 years. SSc patients are less frequently treated with HST after menopause. Menopause occurs earlier and is more often not natural in SSc patients with diffuse disease and aScl70 antibodies. ACR Poster Presentation 467, Oct 2009. |
| Post-Menopause is the Main Risk Factor for Developing Isolated Pulmonary Hypertension in Systemic Sclerosis. Postmenopausal condition alone or in combination with HLA-B35 and CREST syndrome is the main risk-factor for developing primary pulmonary hypertension in scleroderma patients. This suggests that hormonal replacement therapy could play a role in preventing isolated PHT in patients with systemic sclerosis. Neuroendocrine Immune Basis of the Rheumatic Diseases II: Proceedings of the Second International Conference, Volume 966, Jan 2006. (Also see: Isolated Pulmonary Hypertension) |
| Causes of Early Menopause: Autoimmune Disorder. Autoimmune diseases can cause premature menopause. If you have an autoimmune disease, your body’s immune system literally attacks itself. If you have an autoimmune disease that goes after your reproductive system, you may experience early menopause. Life123. |
| 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. |
| 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. |
| 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 |
| Can Tumor Necrosis Factor (TNF) Inhibitors Be Safely Used in Pregnancy? If the activity or disease severity precludes the cessation of a TNF inhibitor and/or DMARD, uncontrolled observations suggest that conception and early pregnancy are not adversely affected by use of TNF inhibitors. Nearly 70% of pregnant patients can discontinue their TNF inhibitor early in the pregnancy (or with determination of pregnancy) without augmenting maternal or fetal risks. Yaser M. Ali J. Rheum. December 15, 2009. (Also see: TNF Inhibitors) |
| Findings Suggest That Adalimumab Exposure in Early Pregnancy Does Not Increase Live Birth Malformation Risk. Preliminary data from a long-term, prospective safety study presented here at the American College of Gastroenterology (ACG) 74th Annual Scientific Meeting suggests that first-trimester exposure to adalimumab does not increase risks for live birth malformations. Bruce Sylvester. Doctor’s Guide. 10/28/09. |
| Systematic review of hydroxychloroquine (Plaquenil) use in pregnant patients with autoimmune diseases. The purpose of this study was to compare the incidence of congenital defects, spontaneous abortions, number of live births, fetal death and pre-maturity in women with autoimmune diseases taking HCQ during pregnancy. It found that HCQ is not associated with any increased risk of congenital defects, spontaneous abortions, fetal death, pre-maturity and decreased numbers of live births in patients with auto-immune diseases. Kirk Sperber Pediatric Rheumatology 13 May 2009 (Also see: Plaquenil) |
| 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) |
| 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). |
| Pregnancy in Systemic Sclerosis: A Prospective Study. Our experience shows that SSc patients with a stable disease, an adequate monitoring and a careful therapy management, can have successful pregnancies. In our series only sporadic complications occurred and some women had more than one pregnancy. Even if some disease symptoms seem to intensify during pregnancy, they probably are physiologic consequences of being pregnant, as suggested by ready disappearance after delivery. M. Taraborelli. (FRI0341) EULAR 2009. |
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| Severe fibrotic changes and altered expression of angiogenic factors in maternal scleroderma (SSc): placental findings. In SSc placentas, severe fibrosis and abnormal vascular remodelling were detected. This may result in reduced blood flow leading to deep sufferance of maternal placenta and possible premature delivery. Lidia Ibba-Manneschi. Ann Rheum Dis. 30 March 2009. |
| 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. |
| 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. |
| 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. |
| 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... |
| Dawn M: Linear/Systemic Scleroderma My family
and I were informed by the doctors, that the localized/linear form of scleroderma that I was diagnosed with, would never progress into the
potentially fatal, systemic form... |
| 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... |
| 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. |
