Autoimmune Diseases and Pregnancy – What to Expect When You’re TTC
As someone with an autoimmune disease, you might be concerned about how pregnancy could affect your health, or about how your disease could affect the health of your future baby. You might even be concerned about whether you will be able to have a baby at all.
Regardless of whether you are struggling with infertility or not, it’s critical to know what to expect when trying to get pregnant with an autoimmune disease. Planning ahead helps you anticipate any potential challenges to your health.
What is an autoimmune disease?
Our immune systems are designed to protect us from foreign invaders, such as bacteria and viruses that can make us sick. However, occasionally, our bodies may mistakenly attack their own cells, confusing them with dangerous intruders.
When the immune system confuses your cells with foreign invaders, you can develop an autoimmune disease. Autoimmune diseases tend to run in families and are much more common in women.
Depending on which organ’s cells the immune system attacks, you may have different symptoms. However, some symptoms are common to many autoimmune diseases, such as:
- Joint pain
- Digestive problems
- Recurring fever
- Swollen glands
However, while autoimmune diseases symptoms are similar across the board, there are many different types of autoimmune diseases you can develop. Below, we’ll look at some of the main forms of autoimmune disease and how they can impact your pregnancy journey.
Systemic Lupus Erythematosus
Systemic lupus erythematosus, known as SLE or lupus for short, is an autoimmune disease that causes inflammation in the connective tissues of the body. These tissues provide support to many structures throughout the body, leading to a wide variety of symptoms caused by the disease.
The earliest and most common symptom of lupus is extreme tiredness or fatigue. You may also feel generally unwell (called “malaise”), develop a fever, or have a butterfly-shaped rash covering the bridge of your nose.
Down the line, lupus can affect many organs throughout the body. About half of people with lupus experience kidney problems, with one-third going on to develop kidney disease. Half of all lupus patients also develop problems with their lungs.
Rheumatoid arthritis, or RA, is an autoimmune disease where the immune system attacks the joints (usually, many joints are affected at once). RA most commonly affects the joints of the hands, wrists, and knees, causing inflammation and damage to joint tissue.
Joint pain from RA may come and go in flares. During an RA flare, you will experience joint pain on both sides of your body (i.e. both knees or both wrists hurt), joint stiffness that is worse in the morning, fatigue, and/or fevers.
Eventually, RA may affect more than just the joints. For example, having RA doubles your risk of heart attack and stroke. It can also cause lung problems, eye problems, and osteoporosis over time.
Scleroderma is another autoimmune disease that affects the connective tissues. Scleroderma may be localized (a milder form that affects only some parts of the body) or systemic (a more severe form that affects more of the body).
The most common symptom of scleroderma is visible thickening of the skin. In localized scleroderma, this thickening is confined to a few areas, while in systemic scleroderma, it may be more widespread.
Systemic scleroderma can also affect the internal organs, including the digestive tract, lungs, kidneys, and heart. This can manifest as heartburn, hypertension, and more.
Your thyroid is a butterfly-shaped organ located at the front of your neck that produces important hormones. There are two autoimmune diseases that affect the thyroid: Hashimoto’s disease and Graves’ disease.
In Hashimoto’s disease, the thyroid is said to be underactive, meaning it produces fewer hormones than it is supposed to. Hashimoto’s disease can cause rapid weight gain, constipation, sensitivity to cold, and more.
In Graves’ disease, the thyroid is said to be overactive, meaning it produces too many hormones. If you have Graves’ disease, you might experience rapid heartbeat, sensitivity to heat, rapid weight loss, or bulging eyes.
How do autoimmune diseases affect fertility?
Autoimmune diseases frequently occur in women of reproductive age. While many women with autoimmune diseases have normal, healthy pregnancies, the risk of infertility is heightened among women with autoimmune diseases.
While the specifics are unknown, it’s thought that autoimmune diseases can affect fertility in a number of ways. Some autoimmune diseases may directly attack the ovaries, negatively impacting your egg reserve. Others, like Hashimoto’s or Graves’ disease, may disrupt normal patterns of ovulation.
How can I manage autoimmune issues before TTC?
The most important thing you can do to have a healthy pregnancy is to keep your autoimmune disease in check. Widespread inflammation, which is caused by nearly all autoimmune diseases, can be harmful to your baby.
The first steps are scheduling a pre-pregnancy consultation and following a healthy lifestyle:
Schedule a pre-pregnancy consultation
Every woman is different when it comes to both pregnancy and autoimmunity. Even if you have the same disease, your symptoms may not look exactly like someone else’s. For this reason, it’s important to talk to the specialist who manages your autoimmune condition before trying to conceive (TTC). Only your specialist knows your unique situation and how it may affect your fertility and pregnancy.
Follow a healthy lifestyle
Maintaining a healthy weight, eating a balanced diet, and exercising appropriately are all important to having a successful pregnancy. Your lifestyle can also help regulate ovulation, improving your overall fertility. Some naturopathic doctors recommend making adjustments like eliminating gluten and taking supplements before TTC with an autoimmune disease, but make sure to check with your doctor before changing your lifestyle significantly.
How do autoimmune diseases affect pregnancy?
If you are TTC, you may be concerned about how your autoimmune disease will affect your pregnancy, and vice-versa.
Unfortunately, the connection between pregnancy and the immune system is not well understood. Some people experience improvements in their autoimmune symptoms with pregnancy, while others find that their symptoms get worse or do not change at all.
The good news is that women with autoimmune diseases can usually go on to have healthy, normal pregnancies. However, you may need to see your OB/GYN more frequently or go to specialist appointments in addition to regular scans and checkups. You will also need to continue or adjust your medication regimen, as your doctor recommends.
Some women with autoimmune diseases may need a special birth plan. For example, if you have Crohn’s disease that affects the perianal region, you might need a C-section to prevent damaging your bowel.
Depending on which medications you take, you also may not be able to breastfeed. Some medications for autoimmune conditions can pass through breast milk to the baby, causing medical problems.
Because autoimmune diseases run in families, you should know that there is a risk that your baby may go on to develop an autoimmune disease. These diseases tend to emerge in young adulthood, so you may not know for a while whether or not they have an autoimmune condition.
Currently, there is no way to predict whether or not your baby will go on to develop an autoimmune disease. However, if you have a disease yourself, know that you will be well-prepared to help your child manage their condition as a parent.
Tips for having a healthy pregnancy with autoimmune diseases
It is possible to have a healthy pregnancy with an autoimmune disease, as long as you take good care of your body.
Ideally, you should reach remission of your autoimmune condition before TTC. Some doctors recommend that you be in remission for at least six months before getting pregnant. Remission lowers your risk of pregnancy complications and of experiencing a flare-up during or after pregnancy.
It’s important to take any medications prescribed by your doctor as directed, even when TTC. You may be worried that the medications will affect your unborn child, but doctors say that unchecked inflammation is more harmful to your baby than these medications.
Lastly, you should make sure to lead a healthy lifestyle during pregnancy. Try to eat healthy, unprocessed foods such as fruits, vegetables, whole grains, and lean protein. You should also keep up with your prenatal vitamins like any other new mom!
Finally, you should ask your doctor about exercises that are safe for you to do during pregnancy, as light exercise can reduce your risk of developing or worsening joint pain during pregnancy.
✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG
Banafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training.
Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.
Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).