title: Pregnancy and autoimmunity: maternal treatment and maternal disease influence on pregnancy outcome.
abstract: If a woman suffers from autoimmune disease (AD), several factors can affect pregnancy or neonatal outcome: repeated spontaneous pregnancy losses (frequently related to antiphospholipid antibodies (aPL)), neonatal lupus with complete congenital heart block (CHB) (linked to transplacental passage of IgG anti Ro/SS-A antibodies) and the disease activity itself that can affect the mother, the pregnancy and fetal outcome. If appropriately managed, the antiphospholipid syndrome (APS) is "one of the few tractable causes of pregnancy losses." A recent case control study, on babies from APS-mothers and healthy mothers, did not show any difference in the occurrence of neonatal complications. There are few data about the long-term outcome of babies born to patients with AD. We recently reported increased occurrence of learning disabilities in children born to aPL positive mothers with systemic lupus erythematosus (SLE). The modern management of pregnancy in patients with AD includes the treatment of disease flares, using drugs effective but safe for fetus. Corticosteroids and some immunosuppressive drugs can be used in pregnancy to control maternal disease. A prolonged fetal exposure to dexamethasone was reported to impair cerebral development, but we recently studied 6 children, born to patients treated with dexamathasone because of CHB, showing a normal intelligence quotient. The last 10-year experience shows that fetal exposure to antimalarial drugs should not be regarded as an important risk factor for gestational nor neonatal complications. However, information about long-term outcome of children exposed to immunosuppressive drugs "in utero" are still lacking and more efforts are needed in this research area.
authors.affiliation: Spedali Civili e Università di Brescia, Brescia, Italy. tincani@bresciareumatologia.it
authors.forename: Angela
authors.initials: A
authors.lastname: Tincani
authors.forename: Chiara Biasini
authors.initials: CB
authors.lastname: Rebaioli
authors.forename: Micol
authors.initials: M
authors.lastname: Frassi
authors.forename: Marco
authors.initials: M
authors.lastname: Taglietti
authors.forename: Roberto
authors.initials: R
authors.lastname: Gorla
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cavazzana
authors.forename: David
authors.initials: D
authors.lastname: Faden
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Taddei
authors.forename: Andrea
authors.initials: A
authors.lastname: Lojacono
authors.forename: Mario
authors.initials: M
authors.lastname: Motta
authors.forename: Laura
authors.initials: L
authors.lastname: Trepidi
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Meroni
authors.forename: Rolando
authors.initials: R
authors.lastname: Cimaz
authors.forename: Anna
authors.initials: A
authors.lastname: Ghirardello
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Pisoni
authors.forename: Marina
authors.initials: M
authors.lastname: Muscarà
authors.forename: Antonio
authors.initials: A
authors.lastname: Brucato
mesh_terms: D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006801:Humans; D008431:Maternal-Fetal Exchange / Q000187:drug effects / Q000276:immunology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D011256:Pregnancy Outcome