Autoimmune conditions occur when immune system abnormalities cause inflammation or pain in the joints, muscles, heart, lungs, kidneys, and skin. For decades, women with these conditions were advised to avoid pregnancy because of the risks, which can include miscarriage, preterm labor, and preeclampsia, a pregnancy-induced high blood pressure.
Now, with proper medical care and counseling before and after giving birth, many women with autoimmune conditions can have safe and successful pregnancies. There are several types of autoimmune diseases, and each affects a pregnancy differently. NYU Langone rheumatologists, who specialize in conditions that affect the joints and muscles, maternal–fetal medicine doctors, and obstetricians work as a team to help you manage these conditions during pregnancy.
If you have these conditions and are considering getting pregnant, our doctors can help you evaluate the risks and determine what precautions you may need to take.
In systemic lupus erythematosus, commonly known as SLE or lupus, the immune system, which is designed to attack viruses and bacteria, instead attacks healthy tissue, causing inflammation and, in time, damage to tissues throughout the body. Lupus can affect the skin, joints, kidneys, blood cells, blood vessels, lungs, and brain. Symptoms often include fatigue, painful and swollen joints, skin rashes, and unexplained fevers.
It had long been thought that pregnancy in women with lupus would result in harm to both the mother and baby, but this has since been proven false. In fact, women can do well if they are in remission—when symptoms subside or go away completely—and seek medical counseling before conception.
Pregnancy-related complications, such as miscarriage, low birth-weight, preeclampsia, and preterm labor, are more common in women with lupus.
Antiphospholipid syndrome is a rare autoimmune condition that causes the blood to clot abnormally. In this condition, a part of the immune system called antibodies mistakenly attacks a type of fat, called phospholipids, and associated proteins that line the blood vessels, damaging the vessels. It can occur alone or along with another autoimmune condition, such as lupus.
Women with this condition have an increased risk of recurrent miscarriage, preeclampsia, preterm labor, and stillbirth. Medications to help prevent blood clots, including low-dose aspirin and low molecular weight heparin, may be used during pregnancy in women with this condition.
Rheumatoid arthritis is a chronic type of arthritis that causes inflammation in the lining of the joints. In this condition, the immune system, which normally fights viruses and bacteria, mistakenly attacks healthy cells in the joints of the ankles, feet, wrists, hands, elbows, knees, and spine, causing inflammation, degeneration of the joint and bone, and pain or swelling.
Some medications given for this condition can cause birth defects or preterm labor, so it’s important to consult a rheumatologist before you become pregnant if you have rheumatoid arthritis.
Symptoms improve during pregnancy in more than half of women with rheumatoid arthritis. Experts aren’t fully sure why, although important clues point toward genes in the baby and mother.
Scleroderma occurs when the immune system, which normally fights infection, instead attacks the body, causing the skin and blood vessels to thicken and tighten, and scars to form on the kidneys and lungs. Localized scleroderma affects the skin, and the systemic type affects the organs and connective tissue, the fibers that bind and support the body’s cells, organs, and tissues. Systemic scleroderma can damage ligaments, nerves, muscles, and tendons and may cause hypertension, or high blood pressure.
Women with systemic forms of scleroderma, which affect many parts of the body, require additional monitoring during pregnancy. They are at risk for developing preeclampsia, which refers to pregnancy-induced high blood pressure and protein leakage in the kidneys, preterm labor, and other kidney problems. Localized scleroderma rarely affects pregnancy.
In Sjogren’s syndrome, the body’s white blood cells, which fight infection, attack the glands that produce moisture, such as those in the eyes and mouth. Diagnosed most often in women, the condition can cause dry and burning eyes, dry mouth, difficulty swallowing, swollen neck glands, and even vaginal dryness. It can also affect the blood vessels, central nervous system, gastrointestinal system, kidneys, liver, lungs, and pancreas.
Primary Sjogren’s syndrome occurs on its own and is not triggered by another condition. Secondary Sjogren’s syndrome develops in a person who has another autoimmune condition, usually rheumatoid arthritis or lupus.
Some pregnant women with Sjogren’s syndrome have a higher risk of miscarriage. Women with Sjogren’s syndrome who have anti-Ro (SS-A) or anti-La (SS-B) autoantibodies—substances in the blood that mistakenly attack the body’s own tissues—are at a higher risk of having a baby born with congenital heart block, a potentially life-threatening condition in which the baby’s heart becomes scarred and beats more slowly.
If you have these autoantibodies, your baby’s heart is monitored in the womb with frequent echocardiograms, a test that uses sound waves to evaluate the heart.
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