Pregnancy and rheumatic disorders

Autoimmune rheumatic diseases commonly affect young women with child-bearing potential. It is important to know the impact of these diseases on pregnancy, and conversely the effect of pregnancy on these diseases, which may have important implications for mothers and neonates. Majority of studies suggest that pregnancy aggravates systemic lupus erythematosus (SLE) disease activity while ameliorating the symptoms of rheumatoid arthritis (RA). This contrasting finding between RA and SLE in pregnancy is postulated to be due to the differences in autoimmune response. There is a raised Th2 type response during pregnancy in comparison to the non-pregnant state, leading to the over expression of Th2 cytokines, such as IL-4 and IL-10. These cytokines are believed to increase the autoantibody response in SLE but to be immunosuppressive in RA. Studies suggest that patients of systemic sclerosis and mixed connective tissue disorder (MCTD) also have worsening of their underlying disorder while paucity of data precludes any solid conclusion regarding disease activity in patients of Sjogren's syndrome. Pregnancies in SLE, RA, systemic sclerosis (SSc) and MCTD patients are associated with a greater risk of relatively poor foetal outcome than in the general population, especially with increased disease activity before conception and early in pregnancy. This review provides an update regarding the effect of pregnancy on autoimmune rheumatic disorders and vice-versa.