The Impact of Autoimmune Disorders and Adverse Pregnancy Outcome

Medical and Sociodemographic Risk Factors for Preterm Birth in a French Caribbean Population of African Descent

“…We found lupus to be associated with an increased risk of spontaneous preterm birth. In previous reports, this association has been explained as a consequence of the high frequency of hypertension, preeclampsia and infections among women with lupus [13][14][15], which was not the case in our population. The prevalence of asthma in our cohort (10.4 %) was close to the recently estimated prevalence in the general population of Martinique (8.8 %) another, very similar, French West Indies Island [16].…”

Pregnancy in Myositis: Challenges and Pitfalls

“…Since optimal pregnancy success can be anticipated if the diseases in remission before conception Váncsa et al, 2007), up to 55% cases present with perinatal morbidity and mortality, mainly fetal growth restriction (Chopra et al, 2008). Conversely, pregnancy in active PM/DM should be considered at high-risk for both the mother and the baby meaning risk for intrauterine retardation, high rate of pregnancy loss (death) or prematurity (Clowse, 2010;Mecacci et al, 2007;Silva et al, 2003;Váncsa et al, 2007). As it appear that the major risk is related to active disease, significant differences in pregnancy course and outcomes in active versus inactive PM/DM subsets have been suggested by most authors: rates of full term birth (72% versus 47%, respectively), intrauterine fetal death (43% versus 13.6%, respectively) and intrauterine growth retardation/premature delivery (33% versus 13.6%, respectively) (Chopra et al, 2008;Silva et al, 2003;Tincani et al, 2006;Váncsa et al, 2007).…”

“…Unfortunately, only a small number of reports on pregnancy outcomes in women with rare autoimmune rheumatic disorders such as PM/DM are yet available. The spectrum of possible adverse effects in pregnant women with myositis varies largely from intrauterine growth retardation and preterm delivery to increase frequency of fetal loss (spontaneous abortion, miscarriage, fetal death), and, finally, even to autoimmune disease in offspring (Borchers et al, 2010;Mecacci et al, 2007). On the other hand, given the relationship between PM/DM and pregnancy three specific categories can be individualized: (i) flare-up/exacerbation of preexisting disease during gestation, (ii) onset of new PM/DM throughout the course of pregnancy, and (iii) postpartum flare or onset of myositis .…”

“…Besides, systemic autoimmune conditions may be induced as a result of maternal hormonal changes and aberrant function of the immune system during pregnancy (autoimmune rheumatic disorders associated with pregnancy) or as a consequence of materno-fetal microchimerism recognized as the longterm persistence of a small number of cells from a genetically distinct organism (autoimmune rheumatic disorders in post-partum period) (Adams Waldorf & Nelson, 2008;Gordon, 2004;Scott, 2002). Over the last decades, most epidemiological studies have focused on pregnancy in systemic lupus erythematosus, anti-phospholipid syndrome and rheumatoid arthritis, with special emphasis on a greater risk of relatively poor fetal outcome than in the general population, particularly with increased disease activity before conception and early in pregnancy (Doria et al, 2004;Doria et al, 2006;Gayed & Gordon, 2007;Mecacci et al, 2007). Pregnancy can also occur in patients with rare autoimmune rheumatic diseases, specifically systemic sclerosis, polymyositis/dermatomyositis, systemic vasculitis (Wegener's granulomatosis, Churg-Strauss syndrome, polyarteritis nodosa, microscopic polyangiitis, Takayasu arteritis) and Behçet disease (Doria et al, 2004;Doria et al, 2006).…”

“…Nevertheless, recent advances in the immunopathogenesis, assessment, monitoring and specific treatment options in patients with systemic autoimmune rheumatic disorders have resulted not only in optimal disease control, improved survival as well as quality of life, but also have been reflected in better pregnancy outcomes. As patients with autoimmune rheumatic disorders are predominantly young women at childbearing potential (between 20 and 40 years), pregnancy is a major issue with prospective interest regarding the influence of both disease and therapy on pregnancy and, conversely, the effect of pregnancy on disease outcomes (Marker-Herman & Fisher Betz, 2010;Mecacci et al, 2007). The physiological adaptation of the immune system to pregnancy (Th2-type response) potentially affects the course of the immune-mediated rheumatic conditions; equally, autoimmunity may compromise the fetal outcomes (Adams Waldorf & Nelson, 2008;Borchers et al, 2010;Marker-Herman & Fisher Betz, 2010).…”