engleski

Autoimmune diseases and pregnancy

This paper reviews perinatal problems of autoimmune etiology of systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), immune thrombocytopenic purpura (ITP) and myasthenia gravis (MG) which are particularly associated with pregnancy loss and obstetric complications. SLE is disease of unknown etiology in which tissues and cells are damaged by deposition of pathogenic autoantibodies and immune complexis. Since SLE is predominantly a disease of young women, pregnancy is a frequent occurrence. Fertility rates are normal in patients with SLE, but the rate of spontaneous abortion and stillbirths is high (30-40 percent), especially in women with antiphospholipid antibodies. If severe renal or cardiac disease is absent and SLE is controlled, many patients complete pregnancy safely and deliver normal infants. Neonatal lupus occurs in infants but is rare, two syndromes are seen: a transient rash and congenital heart AV block. APS refers to the occurrence of thrombosis, recurrent miscarriage, or both in association with laboratory evidence of persistent antiphospholipid antibodies, either lupus anticoagulants (LAC) and/or anticardiolipin antibodies (ACA). It is designated as "primary" when it occurs in isolation, and "secondary" when it arises in association with other diseases such as SLE. Recurrent pregnancy loss is one of the defining diagnostic criteria of APS. ITP is an autoimmune disorder manifested by immune mediated thrombocytopenia. Neonatal alloimmune thrombocytopenia caused by movement of maternal alloantibodies directed against fetal platelet antigens across the placenta that is the most common cause of severe neonatal thrombocytopenia. These antibodies cause thrombocytopenia, which may result in intracranial hemorrhages. Myasthenia gravis (MG) often affects women in the second and third decade of life, overlapping with the childbearing years. The course of the disease is unpredictable during pregnancy ; however, worsening of symptoms occurs more likely during the first trimester and postpartum. MG can be well managed during pregnancy with relatively safe and effective therapies.

autoimmune disease; pregnancy

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