Autoimmine diseases during pregnancy
What is it?
Autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, connective tissue disease, vasculitis, Sjogren's disease, antiphospholipid antibody syndromes, as well as thyroiditis and inflammatory bowel disease, are the prerogative of young women who require careful surveillance during pregnancy, especially if conception occurred when the disease was in active phase. Appropriate preconception counseling should be done to these patients. However, there are patients who discover that they have one of these conditions in conjunction with an adverse obstetric event (miscarriage, preterm delivery, fetal endouterine death, fetal hypodevelopment, preeclampsia, etc.) and require evaluation and appropriate therapy prior to re-pregnancy.
Which are the symptoms?
The clinical picture varies according to the underlying pathology and the organs affected by the different antibodies: there may be fever, arthralgia, skin rash, photosensitivity, neurological symptoms, cardiac, renal, etc., while hematological tests can detect hemolytic anemia, neutropenia, and thrombocytopenia. However, the symptoms are often blurred, and only a clinical evaluation associated with appropriate examinations will allow to make a diagnosis and to set a therapy, especially after an adverse obstetric event or a thrombotic episode.
How is it diagnosed?
Patients with known autoimmune pathology are usually followed-up in rheumatology center where tests and therapy are done: during pregnancy only the necessary tests for the pregnancy itself will be done. On the other hand, if one of these pathologies is suspected near or during pregnancy, targeted haematochemical examinations should be carried out to highlight the presence of antibodies, the inflammatory state and activity of the disease, kidney function, haematological and coagulatory status, and functioning of some endocrine glands such as the thyroid. If organ damage is suspected, the kidney, lungs, central nervous system, skeletal system, thyroid, intestines, large and small blood vessels should be investigated. Sometimes biopsies (e.g. renal or skin) will be required to confirm the picture. Clearly, some tests cannot be done during pregnancy, so a preconception work-up would be more appropriate.
How is it treated?
Patients with known or suspected autoimmune diseases who wish to become pregnant or who are already pregnant are followed-up in the outpatient clinic of Pathology of Pregnancy where there is a gynecologist and an immunologist at the same time. More and more patients with autoimmune diseases are succeeding in carrying a pregnancy to term, thanks to the use of new drugs, both preconceptionally and during pregnancy, such as so-called biological drugs (TNFa inhibitors) or drugs that have been around for some years but have only recently been considered safe for the mother and the fetus (e.g. azatrioprine, hydroxychloroquine). In addition, low-dose aspirin and low-molecular-weight heparin are increasingly used in inflammatory forms or forms associated with the presence of antiphospholipid antibodies, such as antiphospholipid antibody forms related to thrombosis, polyabortion or adverse obstetrical events. Proper treatment of dysthyroidism has been shown to be associated with better maternal/fetal outcomes. The course of pregnancy should be closely monitored for possible complications that, although decreasing, are present in higher percentage than in patients without autoimmune disease, such as fetal hypodevelopment, preeclampsia, hypertension, preterm delivery: will be evaluated with examinations, ultrasounds and timed visits.
Where do we treat it?
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