Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA 95616, USA.
J Autoimmun. 2010 May;34(3):J287-99. doi: 10.1016/j.jaut.2009.11.015. Epub 2009 Dec 23.
There are multiple epidemiological studies that document the potential adverse affects of autoimmunity on nearly every aspect of reproduction, even in the absence of clinically manifest autoimmune disease. Two decades ago, it was suggested that women with autoimmune diseases avoid pregnancy due to inordinate risks to the mother and the child. In contrast, newer epidemiological data demonstrated that advances in the treatment of autoimmune diseases and the management of pregnant women with these diseases have similarly improved the prognosis for mother and child. In particular, if pregnancy is planned during periods of inactive or stable disease, the result often is giving birth to healthy full-term babies without increased risks of pregnancy complications. Nonetheless, pregnancies in most autoimmune diseases are still classified as high risk because of the potential for major complications. These complications include disease exacerbations during gestation and increased perinatal mortality and morbidity in most autoimmune diseases, whereas fetal mortality is characteristic of the anti-phospholipid syndrome (APS). In this review, we will discuss these topics, including issues of hormones, along with potential long-term effects of the microchimerism phenomenon. With respect to pregnancy and autoimmune diseases, epidemiological studies have attempted to address the following questions: 1) Is it safe for the mother to become pregnant or are there acute or chronic effects of pregnancy on the course of the disease? 2) Does the disease alter the course and/or the outcome of a pregnancy and thereby represent an inordinate risk for the fetus and infant? And do new therapeutic and management approaches improve the pregnancy outcomes in women with autoimmune diseases? 3) Does passage of maternal autoantibodies represent a risk to the child? 4) Do pregnancy, parity, or other factors influencing hormonal status explain the female predominance of many autoimmune diseases, and is the pregnancy effect related to microchimerism? Answering these questions has taken on additional importance in recent decades as women in western countries now frequently choose to delay pregnancies and have some or all of their pregnancies after disease onset. In this paper, we primarily focus on APS, systemic lupus erythematosus (SLE), multiple sclerosis (MS), rheumatoid arthritis (RA), and type 1 diabetes (T1D).
有多项流行病学研究记录了自身免疫对生殖几乎所有方面的潜在不良影响，即使在没有临床显性自身免疫性疾病的情况下也是如此。二十年前，有人建议患有自身免疫性疾病的女性避免怀孕，因为这对母亲和孩子的风险过高。相比之下，新的流行病学数据表明，自身免疫性疾病治疗的进步以及这些疾病孕妇的管理同样改善了母婴的预后。特别是，如果在疾病不活跃或稳定期间计划怀孕，通常结果是生下健康的足月婴儿，而不会增加妊娠并发症的风险。尽管如此，由于存在重大并发症的潜在风险，大多数自身免疫性疾病的妊娠仍被归类为高危妊娠。这些并发症包括妊娠期间疾病恶化以及大多数自身免疫性疾病的围产期死亡率和发病率增加，而胎儿死亡是抗磷脂综合征 (APS) 的特征。在这篇综述中，我们将讨论这些话题，包括激素问题以及微嵌合体现象的潜在长期影响。关于妊娠和自身免疫性疾病，流行病学研究试图回答以下问题：1）母亲怀孕是否安全，或者怀孕对疾病的进程有急性或慢性影响？2）疾病是否改变了妊娠的过程和/或结局，从而对胎儿和婴儿构成过高的风险？新的治疗和管理方法是否改善了患有自身免疫性疾病的女性的妊娠结局？3）母体自身抗体的传递是否对孩子构成风险？4）怀孕、生育次数或其他影响激素状态的因素是否解释了许多自身免疫性疾病的女性高发，并且妊娠效应是否与微嵌合体有关？近几十年来，随着西方国家的女性经常选择推迟怀孕并在疾病发作后进行部分或全部怀孕，回答这些问题变得更加重要。在本文中，我们主要关注抗磷脂抗体综合征 (APS)、系统性红斑狼疮 (SLE)、多发性硬化症 (MS)、类风湿关节炎 (RA) 和 1 型糖尿病 (T1D)。
