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| Autoimmunity
and Pregnancy |
 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. |
| Rheumatic
disease increases risks in pregnancy. This
study confirms that women with rheumatic disease
experience greater pregnancy risks
and longer hospital stays than the average pregnant woman.
The findings underscores the need for physicians to monitor
closely their care. innovations report. ACR 2005.
Stanford University Medical Center. 11/15/05. |
| 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 |
| 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 |
| 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). |
| 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. IngentaConnect. 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. |
