Autoimmune disorders in pregnancy

Autoimmune disorders occur in women 5 times more often than in men, and reach their maximum in the reproductive age. Thus, these disorders are commonly found in pregnant women.

[1], [2], [3]

Systemic lupus erythematosus in pregnancy

Systemic lupus erythematosus may first appear during pregnancy; in women who have a history of unexplained stillbirth in the 2nd trimester of pregnancy, restriction of fetal growth, premature birth or spontaneous abortion, often later diagnose systemic lupus erythematosus. The course of pre-existing systemic lupus erythematosus during pregnancy can not be predicted, but systemic lupus erythematosus can worsen, especially immediately after birth. Complications include restriction of fetal growth, premature birth due to pre-eclampsia and congenital heart block under the influence of maternal antibodies penetrating the placenta. Previously significant renal or cardiac complications increase the risk of maternal morbidity and mortality. Diffuse nephritis, arterial hypertension or the presence of circulating antiphospholipid antibodies increase the risk of perinatal mortality. Women with anticardiolipin antibodies (lupus anticoagulant) account for approximately 5-15% of patients with systemic lupus erythematosus and have an increased risk of abortion, stillborn and thromboembolic disorders.

Treatment consists in prescribing prednisone at the lowest dose. It is necessary to take 10-60 mg orally once a day. Some patients are treated with aspirin (81 mg orally once a day) and prophylaxis with sodium heparin (5000-10 000 U.sub./ SC) or low molecular weight heparins. If a woman has severe, non-treatable systemic lupus erythematosus, then the need to continue taking immunosuppressants during pregnancy is treated individually.

Rheumatoid arthritis in pregnancy

Rheumatoid arthritis can begin during pregnancy or, more often, in the postpartum period. The existing symptomatology of rheumatoid arthritis generally decreases during pregnancy. Specific damage to the fetus is not observed, but delivery may be difficult if there are hip joint or lumbar spine injuries in the woman.

Myasthenia gravis

The course changes during pregnancy. Frequent acute myasthenic episodes may require increasing doses of anticholinesterase preparations (eg, neostigmine), which cause symptoms of cholinergic action (eg, abdominal pain, diarrhea, vomiting, weakness); can be prescribed atropine.

Sometimes myasthenia gravis is insensitive to standard therapy and requires the use of corticosteroids or immunosuppressants. During labor, women often need assisted ventilation and are extremely sensitive to drugs that depress respiration (eg, sedatives, opioids, magnesium). Since IgG, responsible for myasthenia gravis, penetrates the placenta, transient myasthenia gravis occurs in 20% of newborns, and more often in mothers who did not have thymectomy.

Immune thrombocytopenic purpura in pregnancy

Immune thrombocytopenic purpura, due to maternal antiplatelet IgG, tends to worsen during pregnancy, and the risk of complications from the mother increases. Corticosteroids decrease levels of IgG and cause remission in most women, but a prolonged improvement in the condition occurs in 50% of cases. Follow-up immunosuppressive therapy and plasmapheresis reduce IgG, increasing the number of platelets. Rarely for refractory cases, splenectomy is required; it is best performed in the 2nd trimester of pregnancy, with a long-term remission achieved in 80% of cases. Intravenous immunoglobulin administration significantly increases the number of platelets, but for a short time, which can induce labor in women with low platelet counts. Transfusion of platelets is used only when a caesarean section is necessary and at a platelet level in the mother is less than 50 000 / μl.

Although IgG can penetrate the placenta, causing thrombocytopenia of the fetus and the newborn, this is rare. The levels of maternal antiplatelet antibodies (measured directly or indirectly) can not predict fetal pathology, but the fetus may be involved even in cases where mothers have been treated with corticosteroids or had a previous splenectomy and lacked thrombocytopenia. A sample of subcutaneous cord blood can be diagnosed. If the number of platelets in the fetus is less than 50,000 / mm3, then intracerebral haemorrhage during labor may occur, and therefore delivery by caesarean section is necessary.