It sounds like something from a horror movie, but sometimes autoimmune conditions cause the body to attack itself. Knowing how to fend off these attacks can help ensure a healthy conception and a healthy pregnancy.
Autoimmune diseases are a group of conditions that occur when the body’s immune system, which is supposed to fight off invaders like bacteria and viruses, malfunctions and begins to attack the body. You’ve probably heard of some of the more common autoimmune diseases: Type 1 diabetes, lupus, multiple sclerosis, rheumatoid arthritis, Graves’ disease, and Hashimoto’s thyroiditis. As much as 15 percent of the U.S. population suffers from an autoimmune condition, and more than three-quarters of those affected are women. These diseases are often first diagnosed in women in their childbearing years. And, not surprisingly, the illnesses can make getting pregnant and having a healthy baby more complicated than usual.
What Makes the Body Attack Itself?
Scientists believe that autoimmune diseases are likely the result of a genetic predisposition that is triggered by a virus or something else in the environment (such as allergens or pesticides) which “turns on” the gene that causes the body to attack itself. Norbert Gleicher, M.D., a fellow of the American College of Obstetricians and Gynecologists and founder and medical director of the Center for Human Reproduction in New York City, explains, “Autoimmune disease is about inflammation. The immune system reacts to cells and creates an inflammatory reaction.” It’s the inflammation that causes the symptoms and the damage.
The various diseases in the autoimmune group are really just different expressions of the message for the body to attack itself. In arthritis, for instance, the joints are attacked. In Hashitmoto’s and Graves’ diseases it’s the thyroid gland. In Type I diabetes the pancreas is attacked, and in multiple sclerosis it’s the nervous system. Symptoms and treatment vary, depending on the specific disease and what part of the body is affected.
Autoimmune diseases tend to run in families, but different members of the same family may suffer from different autoimmune conditions. For example, a woman with rheumatoid arthritis may have a mother with lupus, a sister with Type 1 diabetes, and an aunt with Graves’ disease.
There’s disagreement in the medical community about just how much of an effect these conditions have on fertility and pregnancy. Some doctors are convinced that autoimmune diseases play a major role in fertility problems. Others believe that most of these illnesses don’t directly cause infertility, since most don’t specifically affect the reproductive organs. One thing there’s consensus on is that the medications (such as steroids or methotrexate) that must be taken to control many autoimmune conditions can be very dangerous for a developing fetus. To make things even more complicated, these diseases have flares (periods of time when the symptoms worsen) and remissions, with no warning or explanation. Women with an autoimmune disorder can have a healthy conception and pregnancy, but it may take extra planning and care.
Getting Pregnant While Under Attack
Any woman being treated for an immune disorder needs to discuss her family-building plans with her physician well in advance of “trying,” so that there’s time to get off potentially harmful medications and try to conceive before the disease flares. Women must work closely with their doctors to optimize this window for pregnancy.
Because the safe window for conception—a period that’s medication-free with the disease in remission—may be relatively short, women with autoimmune diseases may turn to fertility treatments more quickly than usually recommended. For a woman with severe rheumatoid arthritis, for example, it may not be feasible to be off drugs for a year (the normal recommended time period to wait before seeing a specialist).
A Cease-Fire During Pregnancy
Happily, many women with autoimmune diseases go into remission while they’re pregnant. Andrew Levi, M.D., a reproductive endocrinologist, founder and medical director of Park Avenue Fertility & Reproductive Medicine in Trumbull, Connecticut, explains, “One-third of conditions worsen, one-third improve, and one-third stay the same. If you can get a woman pregnant while she is not flaring, she is likely to continue not flaring during pregnancy.”
When flares do occur during pregnancy, they generally don’t pose a risk to the baby (although they may be uncomfortable and worrisome for the mom-to-be). “There is no increased risk of miscarriage during a flare,” reassures Dr. Levi. But treating these flare-ups is a delicate matter of carefully choosing medication that will not harm the pregnancy, but will help treat symptoms so a woman can feel as healthy as possible while pregnant.
When the Body Attacks the Baby
As far as the immune system goes, pregnancy is an exception to the rule about fighting foreign invaders. In order for pregnancy to occur, the immune system must allow foreign cells (sperm) to enter the body and eventually grow into a foreign object (the embryo). Most of the time, the immune system knows to tolerate these special foreign bodies.
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