Pregnancy and Reproduction in Autoimmune Rheumatic Diseases
Pregnancy and Reproduction in Autoimmune Rheumatic Diseases
Despite evidence for the important role of oestrogens in the aetiology and pathophysiology of chronic immune/inflammatory diseases, the previous view of an unequivocal beneficial effect of oestrogens on RA compared with a detrimental effect on SLE has to be reconsidered. Likewise, the long-held belief that RA remits in the majority of pregnant patients has been challenged, and shows that only half of the patients experience significant improvement when objective disease activity measurements are applied. Pregnancies in patients with SLE are mostly successful when well planned and monitored interdisciplinarily, whereas a small proportion of women with APS still have adverse pregnancy outcomes in spite of the standard treatment. New prospective studies indicate better outcomes for pregnancies in women with rare diseases such as SSc and vasculitis. Fertility problems are not uncommon in patients with rheumatic disease and need to be considered in both genders. Necessary therapy, shortly before or during the pregnancy, demands taking into account the health of both mother and fetus. Long-term effects of drugs on offspring exposed in utero or during lactation is a new area under study as well as late effects of maternal rheumatic disease on children.
Rheumatic diseases occur preferentially in women, often during the childbearing years. The female preponderance has raised the confirmed conviction that sex hormones play an important role in both disease development and course.
During pregnancy, profound changes of the hormonal milieu take place. The increase of free steroid hormones including glucocorticoids, progesterones and oestrogens, induces changes in functions of immunocompetent cells such as B cells, T cells and monocytes. As a consequence, clinical symptoms of immune-mediated rheumatic diseases are modified related to the prevailing pathophysiological disease process; some improve, while others remain relatively unchanged or worsen during pregnancy.
Pregnancy outcome may be threatened by severe organ involvement and the presence of autoantibodies. Rare diseases with anecdotal pregnancy experience, like most of the vasculitides, pose problems in pregnancy management.
Fetal and neonatal effects of maternal autoantibodies are well known, whereas the long-term outcome of children born to mothers with autoimmune rheumatic disease is still insufficiently studied. Likewise, causes of impairment of fertility in patients with rheumatic disease need more detailed investigation, particularly in males. This survey gives a concise overview of current basic and clinical research into the various aspects of reproduction in rheumatic diseases.
Abstract and Introduction
Abstract
Despite evidence for the important role of oestrogens in the aetiology and pathophysiology of chronic immune/inflammatory diseases, the previous view of an unequivocal beneficial effect of oestrogens on RA compared with a detrimental effect on SLE has to be reconsidered. Likewise, the long-held belief that RA remits in the majority of pregnant patients has been challenged, and shows that only half of the patients experience significant improvement when objective disease activity measurements are applied. Pregnancies in patients with SLE are mostly successful when well planned and monitored interdisciplinarily, whereas a small proportion of women with APS still have adverse pregnancy outcomes in spite of the standard treatment. New prospective studies indicate better outcomes for pregnancies in women with rare diseases such as SSc and vasculitis. Fertility problems are not uncommon in patients with rheumatic disease and need to be considered in both genders. Necessary therapy, shortly before or during the pregnancy, demands taking into account the health of both mother and fetus. Long-term effects of drugs on offspring exposed in utero or during lactation is a new area under study as well as late effects of maternal rheumatic disease on children.
Introduction
Rheumatic diseases occur preferentially in women, often during the childbearing years. The female preponderance has raised the confirmed conviction that sex hormones play an important role in both disease development and course.
During pregnancy, profound changes of the hormonal milieu take place. The increase of free steroid hormones including glucocorticoids, progesterones and oestrogens, induces changes in functions of immunocompetent cells such as B cells, T cells and monocytes. As a consequence, clinical symptoms of immune-mediated rheumatic diseases are modified related to the prevailing pathophysiological disease process; some improve, while others remain relatively unchanged or worsen during pregnancy.
Pregnancy outcome may be threatened by severe organ involvement and the presence of autoantibodies. Rare diseases with anecdotal pregnancy experience, like most of the vasculitides, pose problems in pregnancy management.
Fetal and neonatal effects of maternal autoantibodies are well known, whereas the long-term outcome of children born to mothers with autoimmune rheumatic disease is still insufficiently studied. Likewise, causes of impairment of fertility in patients with rheumatic disease need more detailed investigation, particularly in males. This survey gives a concise overview of current basic and clinical research into the various aspects of reproduction in rheumatic diseases.
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