The implications of autoimmunity and pregnancy

Borchers, Andrea T.; Naguwa, Stanley M.; Keen, Carl L.; Gershwin, M. Eric

doi:10.1016/j.jaut.2009.11.015

Cited by 163 publications

(126 citation statements)

References 121 publications

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“…Finally, PRL has been shown to influence dendritic cells to skew antigen presentation to pro-inflammatory function phenotype, enhancing IFN-α production (28). During pregnancy, one of the most decisive immunologic adaptations is the shift from a Th1/Th17 pro-inflammatory response toward a Th2/T regulatory cell (Treg) response, which promotes tolerance and inhibits natural killer cells cytotoxicity (2,29). In accordance, differences in the activity of assorted autoimmune diseases have been reported during pregnancy and post-partum.…”

Section: Prl and Immune Modulationmentioning

confidence: 99%

Prolactin and Autoimmunity

Orbach

Zandman‐Goddard

Boaz

et al. 2011

Clinic Rev Allerg Immunol

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The great asymmetry of autoimmune diseases between genders represents one of the most enigmatic observations among the mosaic of autoimmunity. Sex hormones are believed to play a crucial role on this dimorphism. The higher prevalence of autoimmunity among women at childbearing ages, disease onset/relapses during pregnancy, and post-partum are some of the arguments that support this hypothesis. Certainly, motherhood represents one of the most remarkable challenges for the immune system, which not only has to allow for the conceptus, but also has to deal with complex endocrine alterations. Hormonal homeostasis is known to exert a crucial influence in achieving a competent and healthy immune system. Prolactin (PRL) has a bioactive function acting as a hormone and a cytokine. It interferes with immune system modulation, mainly inhibiting the negative selection of autoreactive B lymphocytes. Likewise, hyperprolactinemia has been described in relation to the pathogenesis and activity of several autoimmune disorders. Dopamine is an effective inhibitor of PRL secretion due to either a direct influence on the hypophysis or stimulation of postsynaptic dopamine receptors in the hypothalamus, arousing the release of the PRL inhibitory factor. Hence, dopamine agonists have proven to offer clinical benefits among autoimmune patients and represent a promising therapy to be explored. In this review, we attempt to provide a critical overview of the link between PRL, autoimmune diseases, and motherhood.

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Section: Prl and Immune Modulationmentioning

confidence: 99%

Prolactin and Autoimmunity

Orbach

Zandman‐Goddard

Boaz

et al. 2011

Clinic Rev Allerg Immunol

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“…Pregnancy is defined as a specific status of high levels of sex hormones and permanent crosstalk between mother and fetus, two major processes being essentially involved in physiological adaptation to pregnancy: (i) the modification of maternal immune system with subsequent conversion of cytokine profile and (ii) the changes of hormonal milieu throughout the course of gestation (Adams Waldorf & Nelson, 2008;Borchers et al, 2010;Gordon C, 2004). …”

Section: Immunology Of Normal Pregnancymentioning

confidence: 99%

“…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 .…”

Section: Pm/dm In Pregnancymentioning

confidence: 99%

“…Moreover, given the necessity to outline every physician's role in the management of pregnancy and autoimmune conditions there was a strong progress toward an interdisciplinary approach comprising rheumatologists, obstetricians, endocrinologists, immunopathologists, geneticians and neonatologists. It was suggested formerly that women diagnosed with autoimmune diseases should avoid pregnancy due to excessive maternal and fetal risk, as autoimmunity can be reflected virtually on every aspect of reproduction (Borchers et al, 2010;Doria et al, 2006;Gordon, 2004;Peaceman & Ramsey-Goldman, 2008). 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.…”

Section: Introductionmentioning

confidence: 99%

“…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). 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).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pregnancy in Myositis: Challenges and Pitfalls

Ancuţa¹,

Ancuta²,

Chirieac³

2011

Idiopathic Inflammatory Myopathies - Recent Developments

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Association of Maternal Autoimmune Disease With Attention-Deficit/Hyperactivity Disorder in Children

et al. 2021

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IMPORTANCEMaternal autoimmune disease has been associated with increased risk of neurodevelopmental disorders in offspring, but few studies have assessed the association with attention-deficit/hyperactivity disorder (ADHD).OBJECTIVE To examine the association between maternal autoimmune disease and ADHD within a population-based cohort and combine results in a subsequent systematic review and meta-analysis. DESIGN, SETTING, AND PARTICIPANTSA cohort study was conducted of singleton children born at term gestation (37-41 weeks) in New South Wales, Australia, from July 1, 2000, to December 31, 2010, and followed up until the end of 2014; and a systematic review evaluated articles from the MEDLINE, Embase, and Web of Science databases to identify all studies published before November 20, 2019. A total of 12 610 children exposed to maternal autoimmune disease were propensity score matched (1:4) to 50 440 unexposed children, for a total cohort of 63 050. A child was considered to have ADHD if they had (1) an authorization or filled prescription for stimulant treatment for ADHD or (2) a hospital diagnosis of ADHD. Children linked to a first ADHD event before 3 years of age were excluded. Data were analyzed from January 13 to April 20, 2020.EXPOSURES One or more maternal autoimmune diagnoses in linked hospital admission records between July 1, 2000, and December 31, 2012. Thirty-five conditions were considered together and individually. MAIN OUTCOMES AND MEASURESThe main outcome was child ADHD identified from stimulant authorization or prescription data and diagnoses in linked hospital admission records. Multivariable Cox regression was used to assess the association between maternal autoimmune disease and ADHD adjusted for child sex. Pooled hazard ratios (HRs) were calculated using random-effects meta-analysis with inverse-variance weights for each exposure reported by 2 or more studies. RESULTSIn the population-based cohort analysis, 831 718 singleton, term infants born to 831 718 mothers (mean [SD] age, 29.8 [5.6] years) were assessed. Of 12 767 infants (1.5%) who were linked to a maternal autoimmune diagnosis, 12 610 were propensity score matched to 50 440 control infants, for a total study cohort of 63 050 infants. In this cohort, any autoimmune disease was associated with ADHD in offspring (HR, 1.30; 95% CI 1.15-1.46), as was type 1 diabetes (HR, 2.23; 95% CI, 1.66-3.00), psoriasis (HR, 1.66; 95% CI, 1.02-2.70), and rheumatic fever or rheumatic carditis (HR, 1.75; 95% CI, 1.06-2.89). Five studies (including the present study) were included in the meta-analysis. Any autoimmune disease (2 studies: HR,

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The implications of autoimmunity and pregnancy

Cited by 163 publications

References 121 publications

Prolactin and Autoimmunity

Prolactin and Autoimmunity

Pregnancy in Myositis: Challenges and Pitfalls

Association of Maternal Autoimmune Disease With Attention-Deficit/Hyperactivity Disorder in Children

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