Your Complete Guide to Autoimmune Diseases and Pregnancy

We know — autoimmune diseases and pregnancy can be a stressful mix.

As if TTC and being pregnant are not a big enough deal, having a health condition you need to manage adds a whole other layer of complexity.

But there’s good news.

Provided you travel this road with your doctor and get treatment as prescribed, an autoimmune disease does not have to stop you from having a healthy baby. ❤️

We’re going to take you through all the details, including what an autoimmune disease is and the relationship between some of the more common conditions and pregnancy.

In this article: 📝

What is an autoimmune disease?

To understand what an autoimmune disease is, it’s first important to understand a little more about our immune system.

Immune systems are essentially made up of two parts — the innate and adaptive.

We are born with our innate immune system.

It’s ready to protect us quickly and effectively, regardless of what pathogens (viruses, bacteria, microorganisms, and other foreign substances) it encounters.

Then, we have our adaptive immunity, which needs a little more time to become effective.

This is because it first needs to create antibodies, proteins designed to sniff out dangerous invaders (like viruses, harmful bacteria, and cancer cells) called antigens.

Antibodies attach themselves to these antigens and, in doing so, tell our bodies that these intruders need to be cleaned up and eliminated.

When you have an autoimmune disease, your adaptive immune system mistakenly creates antibodies that attack your body’s healthy cells.

And this can cause a range of symptoms, including pain and inflammation, skin conditions, depression, fatigue, and dizziness.

Autoimmune diseases affect about double the number of women as they do men.

There are over 80 known autoimmune diseases, each one with its own individual way of working on your body.

For some people, autoimmune diseases are severe and can have a massive impact on their health and well-being.

Other people have milder symptoms.

But in general, these conditions tend to affect daily life considerably.

Some of the more common autoimmune diseases include:

• Celiac disease
  
• Irritable Bowel Disease (IBD)
  
• Type 1 Diabetes Mellitus (T1DM)
  
• Antiphospholipid syndrome
  
• Lupus (SLE)
  
• Rheumatoid arthritis (RA)
  
• Scleroderma and thyroid diseases (Graves and Hashimoto)

Can you have a healthy pregnancy with autoimmune disease?

The short answer is that, in most cases, it’s definitely possible to have a safe, healthy pregnancy if you have an autoimmune condition.

While pregnancy has the potential to make some autoimmune diseases worse, interestingly, others actually improve when you’re expecting, and some are not affected by pregnancy at all.

And then, some pregnancies can actually trigger an autoimmune disease — so there are no easy answers here.

But many factors come into play here.

The essential thing is to know what autoimmune disease you have, how severe it is in terms of pregnancy, and how to manage and treat the situation.

Regardless, having an autoimmune disease means you will have what is called a high-risk pregnancy.

And while that may sound scary, it really just means that your healthcare team will be monitoring you more closely as your pregnancy progresses.

You never need an excuse to prioritize your own well-being.

And with autoimmune diseases, this is especially true.

But if you’re looking for a reason to look after yourself more than ever, being pregnant or TTC is it.

Does having an autoimmune condition make it harder to get pregnant?

If you’re TTC, some conditions have the potential to affect your fertility, meaning that it may be harder to get pregnant.

But it’s certainly not impossible.

The most important thing is to chat with your doctor as soon as you can.

Getting the conversation going early means you’ll know all your options ahead of time and get your condition in check as best as possible.

You may need to start or continue on a medication regime, make lifestyle adjustments, and, in some cases, have medical procedures done to help you along the way.

It’s also important to note that if your partner has an autoimmune condition, it could lead to fertility issues for them.

And your baby may be more prone to inherit the condition.

So if this is the case, it’s important to talk to your doctor about what the options are.

And if you do get pregnant, congratulations!

Celebrate — and keep up the healthy habits that helped you conceive.

It’s always important to go to all your prenatal appointments, and even more so if you have an autoimmune condition.

That way, you’ll have all the tools available to manage your condition.

What autoimmune diseases make it harder to get pregnant?

These autoimmune conditions can make it harder for some people to get pregnant.

But know that fertility is a complex thing.

And having one of these conditions does not mean you can’t get pregnant.

There’s just a chance it may take longer, or you might need a little help along the way.

Celiac disease

Celiac disease is an autoimmune condition where consuming gluten (a protein found in grains) damages your small intestine.

It’s common — estimates suggest that about 2 million people in the United States have the condition.

Unfortunately, it often goes undiagnosed.

The symptoms of celiac disease vary from person to person.

Gastrointestinal issues like diarrhea, bloating, gas, constipation, nausea, and vomiting are common if you don’t get treatment.

You may also have fatigue, headaches, skin rash, and weight loss.

Celiac disease can also affect your mental health and has strong ties to anxiety and depression.

As you can imagine, having these symptoms while pregnant is no fun.

Research suggests that celiac disease can have some significant ramifications for getting and being pregnant.

A number of studies link celiac disease with TTC troubles and complications during pregnancy — but we’re not 100% sure what the nature of the link is.

It’s also associated with an increased risk of pregnancy loss and might get in the way of the growth and development of your baby.

Celiac disease also puts you at greater risk for nutritional deficiencies, which has a bearing on pregnancy and TTC.

Besides this, the antibodies that build up due to this autoimmune condition may attack the cells in the placenta or in your uterus.

But by avoiding gluten, keeping up with your prenatal checks, and working closely with your doctor to manage your condition, it’s totally possible to have a well-controlled, successful pregnancy.

Rheumatoid arthritis (RA)

If you have RA, your immune system mistakenly attacks healthy parts of your body, mainly the joints, causing inflammation and tissue destruction.

Whether or not rheumatoid arthritis contributes to infertility is up for debate.

We do know that “unexplained subfertility” — where you’re unable to get pregnant after a year of trying — is more common if you have RA.

But this could be linked to the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), like aspirin, ibuprofen, and naproxen, to deal with the symptoms of the condition.

NSAIDs can impact ovulation, fertilization and implantation.

So again, it’s vital to speak to your doctor if you are TTC with RA, as they’ll be able to suggest how to manage your condition so you have the best chance of conceiving.

As for having RA while you’re pregnant, well, it’s also complicated.

For many women — between 50 and 60% — symptoms of RA actually improve with pregnancy because of the changes to the immune system that happen when you’re expecting.

But this is not everyone’s experience.

For other people, pregnancy can cause flare-ups.

There’s also a chance of premature delivery or having a smaller baby, especially if you are on medications like steroids.

So it’s important to be aware that there are certain medications you won’t be able to take while you are pregnant.

The really good news?

There doesn’t appear to be a heightened risk of pregnancy loss or stillbirth if you have RA.

We know we sound a bit like a broken record here, but the best thing is to travel this road with your doctor so that they can adjust your treatment according to your specific pregnancy needs.

Inflammatory Bowel Disease (IBD)

IBD is not to be confused with Irritable Bowel Syndrome (IBS) (which is not an autoimmune condition).

With IBD, your body has antibodies that attack your digestive system.

There are two known IBD conditions, Crohn’s disease (which affects many parts of your digestive system) and ulcerative colitis (which affects only your colon).

Most doctors suggest that you are in remission (no signs and symptoms) for at least six months before TTC.

If you do, it’s definitely possible to have a healthy pregnancy and baby.

If you conceive during an active flare, the risk of your condition continuing throughout pregnancy is high.

There is also a greater possibility of miscarriage, premature delivery, or having a low-birth-weight baby.

In most cases, treatment for IBD can continue during pregnancy.

But speak to your doctor before TTC to get the best outcomes for you and your baby.

Thyroid-related autoimmune conditions

If you have a thyroid-related autoimmune condition, your antibodies attack the cells related to your thyroid.

This means you could end up with either too much or too little of the vital hormones produced by this gland.

When falling pregnant, your thyroid goes into a mild state of hypothyroidism (meaning an underactive thyroid).

Complicate this with a thyroid condition, and you may have multiple challenges, including difficulty falling pregnant and complications during pregnancy.

Sometimes, thyroid disorders can lead to early menopause.

One thyroid condition is Hashimoto’s disease.

This autoimmune disease causes you to have an underactive thyroid (hypothyroidism).

As a result, you can experience a number of symptoms, including goiter (which is when your thyroid gland becomes enlarged), fatigue, constipation, cold intolerance, muscle weakness, and weight gain.

Hypothyroidism can interfere with your menstrual cycle and ovulation, meaning conceiving is harder.

It also comes with an increased risk of pregnancy loss and premature birth if you get pregnant.

Luckily, medication for an underactive thyroid is safe to take during pregnancy.

And you will work closely with your doctor to manage this condition.

Graves disease leads to an overactive thyroid (hyperthyroidism).

It can cause anxiety, tremors, bulging eyes, heat sensitivities, weight loss, and goiter.

This is a serious condition and should not be left untreated as.

Amongst other life-threatening complications, it can also lead to irregular periods and trouble conceiving.

If you are pregnant and have Grave’s disease, your baby could develop a thyroid condition.

There’s also a chance of pregnancy loss and stillbirth.

So it’s really important to work closely with your doctor to identify and manage this condition.

There is some good news here — your condition may improve in the second and third trimesters as hormonal balances shift.

Type 1 Diabetes Mellitus (T1DM)

Diabetes Mellitus is a chronic condition because of too much sugar in your blood.

There are two types of diabetes mellitus (DM).

Type 1 Diabetes Mellitus (T1DM) often develops during childhood.

Your immune system attacks the healthy beta cells in your pancreas

These are the cells that produce insulin.

Without sufficient insulin, your body can’t work with the sugars in your blood.

That means if you have this condition, you have to be treated with external insulin for the rest of your life.

Type 2 Diabetes Mellitus (T2DM) occurs later in life and is generally due to lifestyle choices that make your body more resistant to the insulin it makes.

The good news is that it is possible to have a healthy baby if you have diabetes, provided your condition is well managed.

As soon as you know you are pregnant, it is vital to work closely with your doctor to avoid vision loss, high blood pressure, and kidney disease.

And when it gets close to the birth date, speak to your OBGYN and work out a good birth plan that’s just right for you.

PCOS and endometriosis

PCOS (polycystic ovarian syndrome) is a condition linked to a hormonal problem that interferes with ovulation and causes symptoms like acne, weight gain, and excessive body hair.

(Here are tips for dealing with PCOS.)

Endometriosis is a condition where cells usually found in the lining of the uterus grow outside of it.

Both PCOS and endometriosis can make it harder to conceive.

While they are not classified as autoimmune diseases, they’re important to note here because they function in similar ways and may be linked to other autoimmune conditions.

It is possible to get pregnant with PCOS and endometriosis, particularly with the host of fertility treatments now available to us.

Your best bet, again, is to talk to your doctor as soon as possible.

What autoimmune diseases worsen during pregnancy?

Our bodies are all different, and there’s just no cookie-cutter path for all pregnancies.

Some autoimmune diseases are known to get worse during pregnancy and come with specific risks.

But your journey is your journey, and the best thing to do is to traverse it with your doctor so that they can help you manage your specific condition and how it affects your particular body.

With that in mind, we’ll take you through some of the autoimmune diseases to pay attention to when you’re pregnant.

Lupus

The most common form of lupus is SLE (Systemic Lupus Erythematosus), which mostly affects women of childbearing age.

We don’t know the exact cause of lupus, but the key factors appear to be our hormones, immune systems, and genes.

It is a long-term illness that waxes and wanes.

Symptoms can vary from mild to life-threatening.

One of the most well-known signs of the disease is a butterfly-shaped rash on your face, covering the cheeks and nose.

It can also cause fever, fatigue, mouth ulcers, hair loss, joint pain, and stiffness.

And you may notice that your fingers and toes turn white or blue when you’re cold or stressed (called Raynaud’s Phenomenon).

It’s totally possible to have a safe, healthy pregnancy if you have lupus, particularly if you have the condition under control before you get pregnant.

(The CDC advises that you should be in remission from your symptoms for six months before becoming pregnant.)

But again, this one’s really important to navigate with your doctor.

Some people with lupus have other co-occurring conditions, like high blood pressure and heart and lung issues.

So to keep you and your baby-to-be safe, it’s vital that you get specialist medical attention and advice as soon as you decide you’d like to get pregnant.

Antiphospholipid Antibody Syndrome (APS)

This lifelong autoimmune condition causes your blood to clot too easily.

It can be linked with other conditions, most commonly lupus.

It’s associated with a number of pregnancy complications, including preeclampsia, low blood platelet count, and issues with the placenta.

These conditions can be really dangerous for you and your baby and can lead to pregnancy loss.

Unfortunately, it’s a difficult syndrome to diagnose and is often only found once you have a blood clot, stroke, or multiple miscarriages.

Important: Get medical help immediately if you experience any problems breathing or have stroke symptoms.

Signs of a stroke include trouble walking and talking or moving your arms.

Blood clots often come with breathing difficulties as well as leg pain and swelling.

But there is hope.

APS can be treated, usually with blood thinning medications.

During pregnancy, you’ll have to be monitored quite closely by your medical team so they can adjust your treatment as your pregnancy progresses and check that everything is OK with you and your baby.

Immune thrombocytopenia (ITP)

Unlike APS, ITP means your blood doesn’t clot as it should.

Here your body creates autoantibodies that attack blood platelets, resulting in a low blood platelet count.

Platelets are fragments of blood cells that our blood needs to help clot.

It’s definitely possible to become pregnant if you have ITP — in fact, you may only discover that you have it when you’re pregnant.

It’s common for platelet counts to drop anyway during pregnancy, whether you have ITP or not.

Thrombocytopenia (low platelets in the blood) is defined as having lower than 100,000 platelets per microliter of blood.

But it is only really concerning when that figure dips below 50,000.

Your doctor will manage and treat your condition closely throughout your pregnancy, especially in your third trimester, where you usually see the biggest drop in platelet counts.

If you have ITP, You are more at risk for pregnancy complications like preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).

There’s also a greater chance you could develop iron-deficiency anemia.

Again, it’s definitely possible to have a healthy baby if you have ITP — it’s just really important to get the medical help you need along the way.

Scleroderma

Scleroderma is an autoimmune disease that affects your blood vessels, organs, and skin.

It results in the thickening and tightening of tissues in your body, including your skin and esophagus, and can lead to issues with organs like your lungs, kidneys, and heart.

The good news?

This condition doesn’t appear to affect your ability to get pregnant.

And there’s a good chance you can have a healthy baby if you have scleroderma.

Again, it’s really important that you are consistently monitored and treated as you are more likely to have heart and kidney problems if you have this disease.

Depending on what type of autoantibodies you’re producing, your fetus could be at risk of having low birth weight and, for some, being born with a heart condition.

If you are planning to become pregnant and you have scleroderma, book an appointment with your doctor before TTC so you can be as prepared as possible.

Sjogren’s Syndrome

This normally occurs in middle-aged women, and scientists aren’t quite sure why.

It appears to have a genetic component and ties with other autoimmune disorders, like RA.

In this syndrome, your immune system attacks certain glands, causing dry eyes and mouth.

In some cases, the organs, joints, skin, and nervous system are affected.

Many people with the syndrome experience fatigue and vaginal dryness.

There is not much available information on Sjorgren’s effects on TTC or complications during pregnancy.

But, as we’ve discussed, most autoimmune disorders tend to put both mother and baby at higher risk.

Plus, your chances of developing pulmonary hypertension (when the blood pressure in the vessels between your heart and lungs is too high) goes up.

Again, you can still have a healthy pregnancy if you have this condition.

It’s just vital that you start the conversation early with your doctor and manage the process well throughout.

Myasthenia gravis (MG)

This autoimmune disease causes muscle weakness that often improves with rest.

One of the first signs is extreme fatigue and feelings of really weak eyelids.

If you notice that you can’t keep your eyes open, this may be an early sign.

Thymomas (a tumor growing in your chest) is at the root of about 15% of cases of MG.

So it is important to figure out the cause of your MG.

(Removing the thymoma means you don’t have the disorder anymore.)

There are considerations when TTC or during pregnancy with MG.

Depending on the severity and cause of your MG, you will need a considerable healthcare team to work with you as your pregnancy progresses.

Also, the demands of pregnancy can leave those with MG feeling even more weak and tired.

You may have to have a cesarean because a vaginal delivery may be too exhausting.

Babies born to mothers with MG may have the condition for their first days of life.

That’s because the mother’s autoantibodies are still floating around.

But this usually goes away.

If you have MG, it’s advised that you give birth in a hospital with experience in newborn intensive care so that you and your little one can be properly monitored.

Autoimmune disorders and pregnancy: the bottom line

Yes, autoimmune disorders can impact your fertility and pregnancy.

But it’s still totally possible to have a healthy pregnancy if you have one of these conditions.

Wherever you’re at in your journey, it’s vital to keep in close contact with your doctor and take measures to prioritize your health.

And if you need support along the way, your Peanut community is here for you.

You don’t have to do this alone.