Autoimmunity in obstetrics and autoimmune diseases in pregnancy. (October 2019)

• Record Type: Journal Article
• Authors: De Carolis, Sara; Moresi, Sascia; Rizzo, Francesca; Monteleone, Giuseppina; Tabacco, Sara; Salvi, Silvia; Garufi, Cristina; Lanzone, Antonio
• Is Part Of: Best practice & research. Volume 60(2019)
• Page Start: 66
• Page End: 76
• Publication Date: 2019-10
• Subjects: APS -- SLE -- Pregnancy -- IUGR -- Fetal loss; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2019.03.003
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: Autoimmune diseases (AIDs) are associated with strong female preponderance and often present before or during the reproductive years; consequently, pregnancy and breastfeeding are topics of major interest for these patients. AIDs show different responses to pregnancy: some ameliorate, while others remain unchanged, and several AIDs aggravate. The response of the AIDs to the hormonal and immunological alterations of pregnancy reflects the different pathophysiology of each disease. Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are associated with multiple autoantibodies, multiorgan involvement, more aggressive therapy, and increased impact on pregnancy outcome. For the management of pregnancy in patients with SLE and/or APS, it is important to individuate the correct risk profile for each woman and timing for treatment. The optimal timing for starting or modulating treatment is at preconception assessment to influence the placentation. In this chapter, we discuss the management of pregnancy in patients with AIDs. Highlights: SLE activity in the previous 6–12 months is a predictor of materno-fetal complications. Anti-Ro/SSA and anti-LA/SSB are associated with congenital heart block and neonatal lupus. APS treatment includes preconceptional LDA and heparin at the beginning of pregnancy. For RA, it is crucial to start pregnancy with optimal disease control and safer drug use.