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Autoimmune diseases disproportionately affect women of childbearing age. How do these diseases impact female fertility and pregnancy, and how does pregnancy impact autoimmune diseases?

Autoimmune diseases mistakenly attack healthy body tissue, potentially leading to debilitating symptoms. Over 80 autoimmune diseases are currently known to exist, and they can affect almost any part of the body including organs, connective tissue, nerves, muscles, joints, and hormones. Rheumatoid arthritis, multiple sclerosis, type 1 diabetes, lupus, and Hashimoto's thyroiditis are some examples of more well-known autoimmune disorders.

Autoimmune diseases affect over 23 million Americans alone, though some — like rheumatoid arthritis — are common while others are exceedingly rare.

While anyone can get an autoimmune disease, certain risk factors do exist. Some autoimmune diseases are more prevalent among people of particular ethnic groups, while others may be triggered by environmental factors such as chemicals, viral or bacterial infections, and even sunlight. People with a family history of autoimmune diseases are at an increased risk as well, and it is not uncommon for different autoimmune diseases to affect different members of the same family. 

Women are also at a much higher risk of being affected by an autoimmune disease than men, and the first symptoms often appear during childbearing age.

Trying To Conceive And Being Pregnant With An Autoimmune Disease

Autoimmune diseases sometimes improve during pregnancy, but they can also flare up and cause problems during this crucial time. Some figures suggest that around 75 percent of autoimmune disease patients are women! How do they affect fertility and pregnancy?

Autoimmune diseases do not directly lead to infertility, and many women with various types of autoimmune diseases can safely and naturally conceive and go through healthy pregnancies and uncomplicated deliveries, in part due more advanced treatment becoming available over the last few decades. There are, however, potential challenges with each disease.

With so many different autoimmune diseases, some of which are rare, it is impossible to cover every disease and its potential impact on female fertility and pregnancy. We can take a look at some of the more common autoimmune diseases and how they are likely to affect a woman's chances of getting pregnant, the disease itself, and the pregnancy.

Systematic Lupus Erythematosus

Women going through active episodes of Systematic Lupus Erythematosus (SLE) and receiving corticosteroid treatment may experience anovulatory cycles, during which they cannot conceive. Those with end-stage renal failure as a result of SLE may not experience menstrual cycles at all, while cyclophosphamide treatment can lead to ovarian failure — otherwise known as premature menopause. As long as none of these factors apply, however, women with SLE can be expected to be as fertile as any other woman of a similar age. 

Pregnancy does carry a higher risk of complications for SLE patients, and this is something they should discuss with their healthcare providers before they try to get pregnant. It is not quite clear whether pregnancy increases the risk of SLE flare ups, but research has certainly shown that flare ups are relatively common during pregnancy. They tend to be mild, but can also be severe.

Studies have shown that conceiving during a lupus flare up leads to a higher risk of active lupus during pregnancy as well. 

Women with SLE have a higher risk of having pre-eclampsia, fetal wastage, intrauterine growth restriction, and premature labor, and miscarriages are also more likely to occur in this group. All this means Systematic Lupus Erythematosus is a much more complicated disease to have during pregnancy than many other autoimmune diseases. While research has concluded women with lupus should not be discouraged from having children, the risks and optimal timing of pregnancy should absolutely be discussed with healthcare providers at length. 

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