Autoimmune diseases occur when the body’s immune system mistakenly attacks its own healthy tissues, leading to inflammation and damage. When an autoimmune disease co-occurs with pregnancy, it introduces unique complexities. Pregnancy’s physiological changes can influence disease activity, and the disease itself can impact the pregnancy. Proactive and informed care is essential for the health and well-being of both the pregnant individual and the developing baby.
Pre-Conception Planning for Autoimmune Disease
Careful planning, ideally before conception, is important for individuals with an autoimmune disease. Consulting specialists, such as a rheumatologist and a maternal-fetal medicine specialist, helps optimize disease control. The goal is to achieve remission or low disease activity for at least six months prior to conception, which reduces the risk of pregnancy complications and flare-ups.
A thorough review of all current medications is necessary. Some medications commonly used to manage autoimmune conditions may not be safe during pregnancy and might need to be adjusted or switched to safer alternatives. For example, certain disease-modifying antirheumatic drugs (DMARDs) like methotrexate, mycophenolate, leflunomide, and cyclophosphamide are typically avoided due to potential risks, including birth defects or miscarriage. Discussing potential risks to both the pregnant individual and the baby, along with necessary lifestyle adjustments, prepares for a healthy pregnancy.
Medication Management During Pregnancy
Managing autoimmune conditions throughout pregnancy often involves continuing medication, as active disease can pose a greater risk than some treatments. Healthcare providers weigh the benefits of disease control against potential risks to the developing fetus, individualizing decisions. The goal is to maintain the disease in remission or at low activity to support a healthy pregnancy outcome.
Certain medication classes are compatible with pregnancy. These include antimalarials, such as hydroxychloroquine, often a first-line agent for conditions like lupus, which can provide protective benefits against complications. Some corticosteroids, particularly prednisone, are often used due to limited placental transfer, though high doses are typically reserved for acute flares. Immunosuppressants like azathioprine, cyclosporine, and tacrolimus are also low-risk during pregnancy and lactation, helping to prevent disease flares.
Biologic therapies, particularly tumor necrosis factor (TNF) inhibitors, have a well-supported safety profile during pregnancy and are increasingly used to maintain remission. While evidence on all biologics is still evolving, some, like certolizumab pegol, are considered safe due to minimal placental transfer. Conversely, medications such as mycophenolate mofetil and methotrexate are contraindicated during pregnancy due to significant risks of birth defects and miscarriage, requiring discontinuation well before conception. Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided, especially in late pregnancy, due to potential fetal kidney problems.
Comprehensive Medical Monitoring
Ongoing and comprehensive medical monitoring is important throughout pregnancy for individuals with autoimmune diseases. This often involves a multidisciplinary care team, including an obstetrician, a rheumatologist, and other specialists, to ensure coordinated care. Regular prenatal visits are more frequent to track the health of both the pregnant individual and the baby.
Frequent laboratory tests monitor disease activity markers, organ function, and specific autoantibodies. Testing for anti-Ro antibodies is important, as their presence can indicate a risk of fetal heart block. Monitoring for complications such as preeclampsia, preterm birth, and intrauterine growth restriction is routine, allowing for early intervention. Continuous assessment of symptoms and prompt reporting of changes enable the medical team to adjust treatment plans.
Postpartum Care and Breastfeeding
The postpartum period presents challenges for individuals with autoimmune diseases. Hormonal shifts and immune system reactivation can increase the risk of disease flares. Physical stress from childbirth and caring for a newborn can also contribute to this vulnerability.
Continued monitoring and adjustment of treatment are important in the months after delivery. Healthcare providers anticipate flares and manage symptoms to prevent significant disease activity. Decisions regarding breastfeeding require careful consideration, as medication compatibility with nursing is a factor. Many immunosuppressants and biologics are safe for use during breastfeeding, allowing individuals to continue treatment while nursing.