Women with autoimmune diseases now have much better chances of healthy pregnancies than they did decades ago, but they still face real complications that require careful planning and specialist care. Thanks to advances in research and medicine, doctors can now assess individual risk and help women with conditions like lupus, rheumatoid arthritis, and antiphospholipid syndrome navigate pregnancy more safely than ever before.

What Pregnancy Complications Are More Common With Autoimmune Disease?

Women with autoimmune diseases experience significantly higher rates of serious pregnancy complications. Those with lupus and antiphospholipid syndrome face five times higher risk of preeclampsia (a dangerous high blood pressure condition), preterm birth, and stillbirth compared to women without these conditions. Beyond these major complications, autoimmune diseases are also linked to higher rates of miscarriage and postpartum depression.

Some specific autoimmune conditions carry additional risks. Women with lupus and Sjogren's syndrome may have antibodies that cross the placenta and cause a rare but serious congenital heart condition in their babies. Research has also found higher rates of autism spectrum disorders in children born to women with autoimmune diseases.

How Can Women With Autoimmune Disease Improve Their Pregnancy Outcomes?

The good news is that careful planning and medical management can dramatically reduce these risks. Experts recommend several key strategies before conception:

• Disease Control Timing: Women who conceive while their autoimmune disease is in remission (when inflammation is quiet) rather than during a flare have significantly healthier pregnancies. Waiting for the right moment to try to conceive is one of the most important steps.
• Blood Testing for Risk Assessment: Specific blood tests can identify individual risk factors. For example, a positive test for lupus anticoagulant can identify women at highest risk for preeclampsia, preterm birth, and fetal loss, allowing doctors to provide targeted monitoring and treatment.
• Medication Review and Planning: Some medications used to treat autoimmune diseases can harm a developing baby or reduce fertility and must be stopped before pregnancy. Other medications are safe during pregnancy and can actually improve outcomes, such as hydroxychloroquine, which reduces the risk of fetal heart block in women with anti-Ro antibodies.
• Specialist Consultation: Working with a rheumatologist or maternal-fetal medicine specialist before trying to conceive allows for personalized planning and discussion of potential complications and treatment options.

Low-dose aspirin taken during pregnancy can lower the risk of preeclampsia in women with autoimmune diseases. Additionally, a medication called certolizumab has recently been found to improve pregnancy outcomes in women with antiphospholipid syndrome, which typically carries high rates of pregnancy complications.

For those not planning pregnancy immediately, using effective birth control is an important safeguard. Contraception choices should be discussed with a rheumatologist, as a woman's underlying autoimmune disease can influence which options are best.

What Should You Ask Your Rheumatologist Before Trying to Conceive?

Having a conversation with your rheumatologist well before attempting pregnancy is essential. Experts recommend asking these specific questions to develop a personalized plan:

• Current Disease Status: Is my disease under control enough to try for pregnancy now, or should I wait for better disease control?
• Medication Safety: Are my current medications safe if I become pregnant, or do I need to stop or start any medications before trying to conceive?
• Potential Complications: What are the possible complications I could specifically face during pregnancy given my condition?
• Flare Management: What treatment options would be available if my disease flared up during pregnancy or after delivery?
• Timing and Contraception: If I need to wait to get pregnant due to active disease, how long should I wait, and what contraception is best in the meantime?

"Planning ahead gives the best chance for a healthy pregnancy," explained a rheumatologist and biomedical researcher specializing in reproductive health.

Rheumatology and Reproductive Health Specialist, Medical Expert

What Happens During and After Pregnancy With Autoimmune Disease?

Even with careful planning, autoimmune disease flare-ups can happen during pregnancy, and treating them promptly is important for both mother and baby. The postpartum period also requires attention, as flares after delivery can interfere with a mother's ability to care for her newborn. Fortunately, safe treatment options are available for managing flare-ups during pregnancy and while breastfeeding.

Ongoing care after delivery matters significantly. Women should continue working with their healthcare team to monitor for postpartum complications and adjust medications as needed. With better treatments and growing knowledge, most women with autoimmune disease are now having healthy pregnancies and thriving babies. Fertility options like in vitro fertilization are also safe for many with autoimmune diseases.

The landscape for pregnancy with autoimmune disease has transformed dramatically. What was once considered too risky is now manageable with proper planning, specialist care, and the right medications. The key is starting the conversation with your rheumatologist early and developing a personalized plan that accounts for your specific condition and risk factors.