title: Autoimmune diseases and pregnancy: analysis of a series of cases.
abstract: BACKGROUND
  An autoimmune disease is characterized by tissue damage, caused by self-reactivity of different effector mechanisms of the immune system, namely antibodies and T cells. All autoimmune diseases, to some extent, have implications for fertility and obstetrics. Currently, due to available treatments and specialised care for pregnant women with autoimmune disease, the prognosis for both mother and child has improved significantly. However these pregnancies are always high risk. The purpose of this study is to analyse the fertility/pregnancy process of women with systemic and organ-specific autoimmune diseases and assess pathological and treatment implications.
  
  
  METHODS
  The authors performed an analysis of the clinical records and relevant obstetric history of five patients representing five distinct autoimmune pathological scenarios, selected from Autoimmune Disease Consultation at the Hospital of Braga, and reviewed the literature.
  
  
  RESULTS
  The five clinical cases are the following: Case 1-28 years old with systemic lupus erythematosus, and clinical remission of the disease, under medication with hydroxychloroquine, prednisolone and acetylsalicylic acid, with incomplete miscarriage at 7 weeks of gestation without signs of thrombosis. Case 2-44 years old with history of two late miscarriages, a single preterm delivery (33 weeks) and multiple thrombotic events over the years, was diagnosed with antiphospholipid syndrome after acute myocardial infarction. Case 3-31 years old with polymyositis, treated with azathioprine for 3 years with complete remission of the disease, took the informed decision to get pregnant after medical consultation and full weaning from azathioprine, and gave birth to a healthy term new-born. Case 4-38 years old pregnant woman developed Behcet's syndrome during the final 15 weeks of gestation and with disease exacerbation after delivery. Case 5-36 years old with autoimmune thyroiditis diagnosed during her first pregnancy, with difficult control over the thyroid function over the years and first trimester miscarriage, suffered a second miscarriage despite clinical stability and antibody regression.
  
  
  CONCLUSIONS
  As described in literature, the authors found a strong association between autoimmune disease and obstetric complications, especially with systemic lupus erythematosus, antiphospholipid syndrome and autoimmune thyroiditis.
authors.affiliation: Autoimmune Disease Unit, Department of Internal Medicine, Hospital of Braga, Braga, Portugal. vaniagomes84@gmail.com.
authors.forename: Vânia
authors.initials: V
authors.lastname: Gomes
authors.affiliation: Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal. amfm.mes@gmail.com.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Mesquita
authors.affiliation: Autoimmune Disease Unit, Department of Internal Medicine, Hospital of Braga, Braga, Portugal. carloscapela@ecsaude.uminho.pt.|Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal. carloscapela@ecsaude.uminho.pt.
authors.forename: Carlos
authors.initials: C
authors.lastname: Capela
mesh_terms: D000022:Abortion, Spontaneous / Q000276:immunology; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000276:immunology; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D015551:Autoimmunity / Q000187:drug effects; D018450:Disease Progression; D005260:Female; D005865:Gestational Age; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D050498:Live Birth; D008180:Lupus Erythematosus, Systemic / Q000276:immunology; D011174:Portugal; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D012074:Remission Induction; D012307:Risk Factors; D013967:Thyroiditis, Autoimmune / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents