Chapter 35 - Autoimmune disease in pregnancy

Summary

Pregnancy is associated with a dramatic increase in estrogen and other hormones; consequently, there is the potential for autoimmune disease to worsen during pregnancy. Systemic lupus erythematosus (SLE), lupus nephritis, antiphospholipid syndrome (APS), systemic sclerosis, myasthenia gravis, idiopathic thrombocytopenic purpura (ITP), rheumatoid arthritis, and adrenal crisis are some of autoimmune disorders. This chapter discusses their complications and subsequent management during pregnancy. Flares due to SLE during pregnancy can be treated with hydroxychloroquine and corticosteroids. Hydroxychloroquine, specific complement inhibitors, and tumor necrosis-alpha inhibitors are being evaluated as potential therapies for APS. The first-line therapy for ITP during pregnancy is corticosteroids, typically prednisone. The cornerstone of treatment of myasthenic crisis is to remove circulating antibodies via plasma exchange or to inactivate these antibodies with Intravenous immunoglobulin (IVIG), which are both considered to be safe in pregnancy. Aggressive hydration and glucose replacement are advised for adrenal crisis.