Autoimmune diseases and pregnancy

Autoimmune rheumatic diseases (ARD) occur frequently in women during their childbearing years and may influence pregnancy outcome and neonatal health. Patients with systemic lupus erythematosus (SLE) can experience a disease flare-up during pregnancy with potential negative effects on the product of conceptus, especially if the disease is active. Therefore SLE, as well as other ARD, need to be treated during pregnancy. Drugs used in pregnant patients need to be carefully evaluated for their possible foetal damage. In this respect a recent consensus report on the use of anti-rheumatic drugs in pregnancy, indicates that corticosteroids, antimalarials and some immunosuppressive drugs can be administered to pregnant patients when needed. Recurrent pregnancy loss is now considered as a treatable clinical condition associated with the presence of circulating antiphospholipid antibodies (aPL) within the SLE (or other autoimmune disease) setting or in otherwise healthy women (antiphospholipid syndrome, APS). Nevertheless APS patients have to be strictly monitored during pregnancy and puerperium because of the high risk of thrombosis recorded also in patients without previous thrombo-embolic events. Patients affected by rheumatoid arthritis (RA) are generally found less symptomatic during gestation, however they need a careful pre-conception counselling because a) the disease is generally treated with drugs (i.e. methotrexate) that are teratogenic, therefore pregnancy must be planned, and b) patients should be informed that the relapses are frequently reported in the three-four months after delivery possibly causing serious problems in the neonate care and consequent depression in the mothers; familiar strategies should be available for the patients to overcome these difficulties. Nowadays, owing to our increasing knowledge of the disease patho-physiological mechanisms and the development of combined medical-obstetric clinics, pregnancy outcome in patients with AD has notably improved.