How Autoimmune Diseases Impact Female Fertility And Pregnancy | Autoimmune diseases articles | Body & Health Conditions center

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.

Female Reproductive Health And Autoimmune Diseases

Rheumatoid Arthritis

Rheumatoid arthritis does not lead to subfertility or infertility, and the condition often actually goes into remission during pregnancy. The reason is not known yet, but a less active "pregnancy immune system" might be to thank. Though this is good news for many women with RA who are pregnant or would like to conceive, not all expectant moms with rheumatoid arthritis are symptom-free, and some have flare ups.

Up to half will need medication while they are expecting, and that is where potential problems come in: not all medications for RA are safe during pregnancy, and even those that are can cause undesirable side effects.

Prednisone has been deemed safe once the first trimester is over, and the same goes for Plaquenil. These medications do put women at a higher risk of hypertension — which in turn raises the risk of the life-threatening condition preeclampsia — and high blood sugar levels. Pregnant women taking Prednisone will need extra vitamin D and calcium to protect their bone health as well.

Type 1 Diabetes

Women with type 1 diabetes, particularly poorly controlled diabetes, still have a higher risk of pregnancy complications. For the baby, these risks include miscarriage, premature labor, birth defects, a very large baby, hypoglycemia at birth, and breathing difficulties. Diabetes-related eye and kidney problems can worsen during pregnancy, and preeclampsia and a difficult delivery are also potential problems for diabetic mothers.

The key to a healthier pregnancy is ensuring maternal blood glucose levels are within the target range when she conceives and during the first trimester of pregnancy, but also beyond.

Planning a pregnancy carefully and having excellent blood glucose control for six to three months before attempting to conceive are good ideas. Keep in mind that many medications used to treat diabetes are not safe during pregnancy. ACE inhibitors and statins are examples. The medical issues surrounding diabetes during pregnancy make discussing family planning with their healthcare team absolutely essential for women with the disease.

Multiple Sclerosis

Multiple Sclerosis strikes women of reproductive age more than any other group of people. Fortunately, there is no evidence that MS leads to fertility problems, an increased risk of miscarriages, or birth defects. Women with Multiple Sclerosis were told to avoid getting pregnant before 1950 because doctors believed pregnancy would worsen the disease.

Since then, research has consistently shown the opposite to be true — the risk of MS relapses is smaller when a baby is on the way, especially during the second and third trimesters.

Relapses are more likely to happen during the immediate postpartum period, however, and the fact that many MS medications are not approved for use during pregnancy does mean getting pregnant with MS is not necessarily completely straightforward. Women whose mobility has been affected by MS may well find that their problems increase while they are expecting a baby, and the may need to rely on walking sticks or wheelchairs.

Want To Conceive With An Autoimmune Disease?

If you are a woman with an autoimmune disease and you'd like to get pregnant, it is likely that your disease will impact your reproductive life in some way. Likewise, a pregnancy can influence the disease you have positively or negatively. Not all medications are safe for use during pregnancy, and in some cases it is very important that healthcare and lifestyle changes are implemented some months before you start trying to conceive.

All these factors can only lead to an extremely simple bit of advice: any woman who was diagnosed with an autoimmune disease and is either thinking about getting pregnant now, or might possibly want children in the future should talk to her healthcare team about fertility, pregnancy, and the disease.

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