Is There Increased Risk for Preeclampsia in Moms with Autoimmune Disease?
Is preeclampsia a higher risk in pregnancies of women who have autoimmune conditions? Why?
Preeclampsia is a medical disorder of pregnancy occurring after the 20th week. Women with preeclampsia have elevated blood pressure, protein in their urine, and usually increased swelling. If preeclampsia is severe, it poses a real health risk to the health of both mom and baby.
Taken as a group, women with diagnosed autoimmune conditions do appear to have a higher risk of getting preeclampsia during pregnancy. For example, one study found that preeclampsia occurred in 18% of pregnancies of women with rheumatoid arthritis and 17% of pregnancies of women with lupus; their respective control groups had rates of 7% and 9%. There is also some limited evidence that your risk may be higher if you have a more severe form of your autoimmune illness.
Scientists do not fully understand why autoimmune diseases increase the risk of preeclampsia. This is perhaps not surprising, given the partial understanding we have of both conditions. The cause of preeclampsia is likely complex, but immunological alterations appear to play a role. Most women with preeclampsia form antibodies to receptors for an important hormone—angiotensin II. This hormone plays a critical role in the renin-angiotensin system, which regulates blood pressure and fluid balance. Through a complex series of events, antibody stimulation of these hormone receptors may lead to the symptoms of preeclampsia. Some scientists even think preeclampsia itself should be classified as a type of autoimmune disease. Autoimmune diseases are of course characterized by antibodies and other immune system components which attack normal cells.
It’s not clear if having the autoimmune disease itself is what puts a person at increased risk of preeclampsia. It may be that certain genetic and environmental factors put a person at increased risk of autoimmune diseases in general, including preeclampsia.
Are some autoimmune conditions more susceptible to preeclampsia than others?
In this context, scientists have studied certain autoimmune diseases more than others, which makes comparisons difficult. One of the conditions most studied is antiphospholipid syndrome (APS). In this disorder, antibodies form against phospholipids in cells, causing clots to form in arteries and veins. APS is also well known to cause various problems in pregnancy, including repeated miscarriages and preeclampsia. APS is in fact a risk factor for severe preeclampsia and eclampsia, a more serious condition that can develop from preeclampsia. Women with preeclampsia are more than twice as likely to have these autoantibodies, even if they do not qualify for a diagnosis of APS. Many women with lupus are also positive for the antibodies; they may be at especially increased risk of preeclampsia as well.
Elevated risk of preeclampsia has also been found in other specific autoimmune disease. These include rheumatoid arthritis, autoimmune thyroid disease, and type I diabetes. Preeclampsia risk may not be elevated in every type of immune disease, however; vitiligo, for example has not been found to be associated with increased risk.
Do I need to do anything different as an autoimmune mom from other moms with risk for preeclampsia?
The short answer is, no. There is no known way to prevent preeclampsia, whether one has an autoimmune condition or not. If possible, reduce any modifiable risk factors for preeclampsia: if you are obese, lose weight before you become pregnant. If possible, plan to have your children before the age of 35, since older age increases the risk of preeclampsia as well.
It seems reasonable to work especially hard to control your autoimmune symptoms while you are pregnant. Do everything you would normally do to help prevent disease exacerbations: get enough sleep, eat a good diet, manage your stress level, etc. Talk thoughtfully with your doctor about the drugs for your autoimmune disease which you might or might not continue to use during pregnancy. Be diligent about making all of your prenatal appointments so you can be monitored for the onset of preeclampsia.
On the flipside, if I had preeclampsia during pregnancy, am I at higher risk to develop an autoimmune condition at some point post-partum?
Maybe. There is very little data available on this question. One study showed that women who had preeclampsia had a higher risk of developing scleroderma later. Some women do report the onset of autoimmune diseases after a pregnancy with preeclampsia, but this may be coincidence, since many autoimmune diseases begin during the childbearing years. In general, having one autoimmune condition does put you at higher risk of developing another. If preeclampsia is a true autoimmune condition, you might be at higher risk of developing another one in the future.
Questions for your doctor
- What are the possible risks and benefits of staying on my medications for autoimmune disease during my pregnancy?
- What are other issues to consider when planning for a baby for someone with my autoimmune condition?
- If I am a pregnant woman with autoimmune disease, should I restrict my salt intake early in my pregnancy?
About the Author
Ruth J. Hickman, MD, is a freelance health, science, and medical writer. She specializes in writing about medical topics for the lay public and for health science students. She can be reached at firstname.lastname@example.org or through her website: ruthjhickmanmd.com.
This blog post was originally published by AutoimmuneMom.com, written by Ruth J. Hickman, MD, and first published on Mar 15, 2013.
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