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The effects of pregnancy on autoimmune diseases

To maintain a successful pregnancy, the maternal host must  somehow bypass or compensate for the usual immunological processes developed to ensure recognition and elimination of non-self molecules. Accordingly, it has been proposed that a bi-directional interaction between the maternal  immune system and the reproductive system (feto-placental unit) may result in the redirection of maternal immunity away from cell-mediated immunity and toward enhanced humoral responsiveness [1].

In this model the conceptus protects itself by secreting TH2 cytokines that down-regulate TH1 cytokines such as interleukin-2, interferon-g, and tumor necrosis factor, which are generally harmful to the maintenance of pregnancy [1].

The course of an autoimmune disease might be altered as immunological adaptations facilitate intrauterine implantation of the blastocyst and maintenance of the fetal semi-allograft. Logically, a preexisting autoimmune disease in the mother may influence the outcome of pregnancy. As improvement in the morbidity and mortality of autoimmune diseases continues, these issues assume increasing importance.

Commonly encountered autoimmune diseases are rheumatoid arthritis (RA) with a frequency of about 1–2% in the general adult population, 3:1 female to male ratio, and peak incidence age 65–74 years;  systemic lupus rythematosus(SLE), which has a striking female predilection of 10:1, frequency of 1 per 700 women, and peak incidence around age 30; Sjogren’s syndrome (SS), which may be primary or associated with a defined autoimmune disease such as RA or SLE, and which has a female predilection of about 9:1 and mean age of onset of about 50 years; and scleroderma, which has a female predilection of 3:1 (10:1 in ages 15–44), frequency of 1 per 10,000, and mean age of onset of symptoms in the early 40’s [2].

The presence of highly specific autoantibody profiles in the mother, regardless of whether or not she has a clinical disease, is associated with fetal demise and the neonatal lupus syndromes.

The former is associated with antiphospholipid antibodies and the latter with antibodies directed against SSA/Ro and SSB/La polypeptides.

REFERENCES

[1]. Wegmann, T. G., Lin, H., Guilbert, L., Mosmann, T. R. (1993) Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol. Today 14, 353–356.

[2]. Petri, M. (1997) Rheumatic Disease Clinics of North America, Vol. 23, No. 1. Pregnancy and Rheumatic Disease. Philadelphia: Saunders, 1–218.

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