Introduction
The human body has a defense system called the immune system. The immune system includes cells, tissues, and organs, and it works against foreign organisms that have the potential to cause infections in the human body. However, the immune system can sometimes attack not just the invading organisms but also the body’s healthy cells, tissues, and organs, and this disease condition is termed an autoimmune disease; depending on where the immune system attacks, the disease presentation changes. Rheumatic disease is one such autoimmune disease condition.
What Are Rheumatic Diseases?
Rheumatic diseases are a group of autoimmune conditions that mainly affect the joints, bones, muscles, ligaments, and tendons of the human body. There are many types of rheumatic diseases. However, some common rheumatic diseases are:
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Rheumatoid Arthritis - This is a disease condition that causes inflammation in the joints and bones and progresses to other organs of the body.
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Systemic Lupus Erythematosus - An autoimmune disease that can mainly affect the skin and also includes joints, kidneys, and heart.
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Fibromyalgia - A chronic condition that causes widespread pain and tenderness in the muscles and soft tissues of the human body.
Factors such as genetics (specific genes), environment (infections), gender (women), and age (old age) make certain individuals more prone to the development of rheumatic diseases. Studies have shown that women, especially from the age of puberty (first menstrual cycle) until menopause (menstrual cycles stop), are more prone to rheumatic disease development.
What Makes Women More Prone to Rheumatic Diseases?
The exact reason why women are more prone to rheumatic diseases is unknown, but studies have shown that it may involve a combination of hormonal, genetic, environmental, and reproductive factors.
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Hormones - Women have hormones such as estrogen, androgen, and prolactin. The hormone profile is different for men and women. Studies have shown that estrogen, androgen, and prolactin hormones may make women susceptible to autoimmune diseases.
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Genetic Factors - Women have a chromosomal profile of XX, and men are XY. The X chromosome is known to have genes that regulate the immune system. A defect or mutation in these genes can cause autoimmune diseases. Women have two X chromosomes, which increases the chance of having more mutations in these genes and, hence, are more prone to autoimmune rheumatic disease.
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Environmental Factors - Women are more prone to infections and toxicities due to an unhealthy lifestyle with a lack of adequate sleep, improper diet, and no practice of exercise. These factors also contribute to women being more prone to rheumatic diseases.
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Reproductive Factors - During pregnancy and menopause, the hormone profile changes for a woman. For example, during pregnancy, the estrogen hormone increases, while during menopause, the estrogen hormone decreases. These changes may influence a woman's risk of developing rheumatic diseases or the symptoms of an ongoing rheumatic disease.
How Does Pregnancy Affect Rheumatic Diseases?
Depending on the health and type of rheumatic disease a woman has, the effect of pregnancy on the disease varies.
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Women with rheumatic diseases experienced an improvement in the disease symptoms or a period of remission (absence of disease symptoms) when pregnant. However, the symptoms were aggravated (flares) for most women during the first three to twelve months of post-delivery for most.
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Women with rheumatic diseases such as systemic lupus erythematosus are advised to have a controlled disease status before getting pregnant, as women may experience incidents of flares a few months into the pregnancy or a few months after delivery. Whereas, when pregnancy is planned after observing the absence of symptoms for a minimum of three months, these episodes of flares are not experienced.
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Furthermore, complications could occur when the blood pressure in the arteries of the lungs and heart increases (pulmonary hypertension). Women with the condition that is likely to have complications of rheumatic diseases are advised against pregnancies, as these complications could turn fatal for both the mother and the fetus.
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Women with rheumatoid arthritis experience improvements in symptoms when pregnant and experience a progression in improvement proportional to the progression of pregnancy. However, most of the individuals also observed a flare of symptoms a few months after delivery.
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Women with fibromyalgia experience extreme episodes of flare, where the inflammation in the bones, muscles, and joints is severe. Although complications such as low birth weight and miscarriages are a possibility, most women with fibromyalgia deliver healthy babies.
The post-delivery flare of symptoms could be due to the increased levels of prolactin, which worsens the inflammatory responses of the human body.
How Do Rheumatic Diseases Affect Pregnancy?
The degenerative and inflammatory nature of rheumatic diseases could have negative effects on pregnancy. Rheumatic diseases like systemic lupus erythematosus have the potential to affect internal organs such as the kidney and liver and cause life-threatening complications. The presence of such diseases could cause complications during pregnancy or delivery. Some of the common conditions seen in a pregnant woman as an effect of rheumatic diseases are as follows:
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Early or late miscarriages.
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A rise in blood pressure and signs of damage to the kidney and liver (preeclampsia).
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Worsen symptoms of existing health conditions such as kidney disease.
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Thrombosis (a condition where blood clots within blood vessels).
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Flares of rheumatic disease symptoms during pregnancy or within a few months of delivery.
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Birth of the baby before 37 weeks (premature birth).
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The child weighs less than 5.51 pounds at birth (low birth weight).
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Children born to mothers with anti-Ro antibodies (antibodies found in individuals with diseases like systemic lupus erythematosus) were seen to have defects or dysfunction of the heart (congenital heart diseases).
Furthermore, the medications for rheumatic diseases may interact with pregnancy and cause side effects for the mother or child. The benefits of rheumatic medications are outweighed by the potential risks of the same before choosing to have any medication. Both rheumatologists and gynecologists need to be aware of the disease condition of pregnant women before prescribing medication or advising them to stop an ongoing medication.
How Should Pregnant Women With Rheumatic Diseases Be Managed?
Close monitoring of the pregnant woman can avoid complications and help with healthy deliveries. Some of the measures that need to be taken are:
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Plan pregnancy after a minimum of three months or six months of remission of rheumatic diseases.
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Continue ongoing medications to avoid symptom flares.
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To avoid the risk of preeclampsia, Aspirin is advised in a low dose.
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Medication such as Captopril is safe during pregnancy and is advised for women with high blood pressure.
Conclusion
Generally, women with rheumatic diseases or at risk of developing rheumatic diseases may have a safer pregnancy and delivery. However, this varies among individuals. Medical counseling is advised for women who have rheumatic diseases and plan to get pregnant. A properly controlled ongoing rheumatic disease will have a stress-free pregnancy period. However, close monitoring of both the mother and the baby is required to intervene and prevent probable complications at the earliest.
