Many autoimmune conditions arise during periods of exceptional stress. Considering how taxing pregnancy is on the body, it’s no surprise that autoimmune diseases can emerge or worsen, both during and after. The relationship between pregnancy and autoimmunity is a two-way street — pregnancy can influence autoimmunity, and autoimmunity can affect pregnancy. Beyond that, there are connections between fertility and autoimmunity. In this article, we’ll explore these relationships and offer tips for a healthy, safe pregnancy. (Source, Source)

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Can Pregnancy Cause Autoimmune Disease?

It’s uncommon, but the changes that happen within the body during and immediately following pregnancy can trigger certain autoimmune diseases. 

Rheumatoid Arthritis

Rheumatoid arthritis rarely presents during pregnancy, but some women develop the condition postpartum. This typically happens within nine months of giving birth to a first child. Unfortunately, figuring out that you’ve developed rheumatoid arthritis postpartum can be challenging, as many of the symptoms of rheumatoid arthritis overlap with typical postpartum experiences, such as swelling, joint pain, and fatigue. (Source, Source)

Graves’ Disease

Hyperthyroidism, or overactive thyroid, happens in 0.1%–0.4% of pregnancies in the United States. When it occurs, hyperthyroidism in pregnancy is typically caused by Graves’ disease. The risk of developing Graves’ during the first year after giving birth is significantly higher than in the general population. Signs of Graves’ disease can be subtle, including sensitivity to heat, fatigue, and irritability, or more obvious, such as a rapid heartbeat, an enlarged thyroid (which can be felt as a lump in the front of the neck), or painful, bulging eyes. (Source, Source, Source)

Hashimoto’s Disease

Compared to the hyperthyroidism associated with Graves’ disease, hypothyroidism, or underactive thyroid, is much more common during pregnancy and occurs at a rate of 2%–3%. Hypothyroidism during pregnancy is typically a result of Hashimoto’s disease. In people with Hashimoto’s disease, the thyroid is under attack by antibodies created by a malfunctioning immune system. The resulting damage affects the thyroid’s ability to make essential hormones. Hashimoto’s and Graves’ share some common symptoms, such as fatigue and irritability, while other symptoms of Hashimoto’s, including sensitivity to cold and a slow heart rate, are opposite to those of Graves’. (Source)

Type I Diabetes

Gestational diabetes, which is high blood sugar that develops during pregnancy, is not an autoimmune condition. However, research shows that women who have gestational diabetes are more likely to develop type I diabetes (an autoimmune condition) after pregnancy. That isn’t to say that pregnancy  causes type I diabetes, though. It could be that people who are predisposed to gestational diabetes are also predisposed to type I diabetes, and they might have developed type I diabetes regardless of whether or not they ever became pregnant. More research is needed to determine the nature of the relationship between type I diabetes and pregnancy. While it’s uncommon, there have also been cases where women developed type I diabetes during pregnancy. (Source, Source, Source, Source)

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How Does Pregnancy Affect Existing Autoimmune Conditions?

Rheumatoid Arthritis and Pregnancy

During pregnancy, many people with rheumatoid arthritis experience a period of remission. More research is needed to determine why this is such a common occurrence, but it is likely related to alterations to the mother’s immune response that are needed to maintain pregnancy. Without these alterations, her body might reject the fetus as foreign tissue. (Source)

Remission of symptoms usually doesn’t continue once the baby is born, though, and up to 90% of women with rheumatoid arthritis may experience a flare postpartum. Typically, the flare happens within three months of giving birth. (Source)

Graves’ Disease and Pregnancy

People with Graves’ disease may find their symptoms improve during the second and third trimesters because some parts of the immune system are less responsive during these periods. Thyroid stimulating hormone (TSH), which is present in excessive quantities in people with Graves’ disease, is produced more conservatively by the body in response to the changes that happen during the second and third trimesters, which may explain the improvement. 

As TSH levels increase in the postpartum period, many people with Graves’ will experience worsening symptoms within the first few months of giving birth. (Source)

Hashimoto’s Disease and Pregnancy

The thyroid undergoes major changes during pregnancy, even in people without thyroid disease. For the same reason that people with Graves’ may notice an improvement in symptoms (TSH is produced more conservatively), people with Hashimoto’s will likely notice exaggerated symptoms. These effects are likely to persist postpartum. (Source, Source)

Inflammatory Bowel Disease and Pregnancy

Research shows that pregnant women with inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, experience flares at the same rate as those who aren’t pregnant. However, if you conceive during a period of remission, you’re more likely to stay in remission through your pregnancy than someone who conceived during a period of active disease. Likewise, a person who delivers during a period of remission is more likely to experience fewer flares in the months following delivery. (Source, Source)

Psoriasis and Pregnancy

Plaque psoriasis is the most common type, affecting about 80% of people with the condition. During pregnancy, about half of people with plaque psoriasis experience a significant improvement in symptoms, particularly toward the end of the first trimester and through the second. Rarely (in 10%–20% of people), psoriasis symptoms worsen during pregnancy. 

In the majority of cases, people with psoriasis will experience a flare within six weeks of delivery. However, the flare isn’t likely to be particularly severe and should be comparable to a pre-pregnancy flare. (Source, Source)

Multiple Sclerosis and Pregnancy

Studies show that people with multiple sclerosis are less likely to experience a relapse during pregnancy, especially throughout the last trimester. But, unfortunately, the improvement isn’t persistent, and most people return to their pre-pregnancy rate of relapse within a few months of delivery. (Source)

Systemic Lupus Erythematosus and Pregnancy

There’s conflicting evidence on the effect of pregnancy on lupus symptoms. It seems that in most cases, though, people with lupus notice a deterioration in their condition during pregnancy. For most people, that just means an exceptionally uncomfortable pregnancy. Evidence shows that 15%–30% of people with lupus will likely experience a moderate to severe flare during pregnancy. (Source)

How Does Having an Autoimmune Condition Affect Fertility and Pregnancy?

Thanks to advances in medical care, many people with autoimmune disorders who would not have been able to successfully carry a child a few decades ago are now able to have healthy, safe pregnancies. However, if you have an autoimmune disease and you’re pregnant or trying, you should know that your autoimmune condition will likely affect your pregnancy experience.

Rheumatoid Arthritis

The road to conception is sometimes longer in women with rheumatoid arthritis. Rheumatoid arthritis is thought to affect fertility rates directly, and many women who are taking medications for their condition need to allow extra time to adapt to new medications (more on that below) before trying to conceive. Unexplainable subfertility, or delay in conceiving, is significantly more common in people with rheumatoid arthritis than in those without. (Source)

Women with rheumatoid arthritis are no less likely to carry to term and have a successful delivery than others. However, people with active rheumatoid arthritis during pregnancy are more likely to deliver low-birthweight babies who may be born early. (Source)

Graves’ Disease

Graves’ disease is associated with an irregular menstrual cycle, which can make getting pregnant challenging. Poorly managed Graves’ disease is also linked to complications, including miscarriage and preeclampsia (a serious complication characterized by exceptionally high blood pressure, protein in the urine, and swelling). If you’re pregnant or considering becoming pregnant, discuss your plans with your health care provider as early as possible so you can take the necessary steps to improve your likelihood of carrying and delivering successfully. (Source, Source)

Hashimoto’s Disease

Like those with Graves’ disease, women with Hashimoto’s often have irregular menstrual cycles, which can make it difficult to get pregnant. And similar to Graves’, poorly managed Hashimoto’s can lead to complications during pregnancy and delivery. Given pregnancy’s effects on the thyroid, anyone with a thyroid condition should seek advice from a health care provider, preferably before conceiving but at least early in their pregnancy. (Source, Source)

Inflammatory Bowel Disease

Ulcerative colitis doesn’t seem to affect fertility, but certain ulcerative colitis treatments, such as bowel resection surgery, may impact a woman’s ability to carry. Active Crohn’s disease, on the other hand, can reduce the likelihood of conception. This is likely because of severe inflammation in the small intestine that can negatively affect the condition of the fallopian tubes. However, fertility returns to average levels when the disease is well-managed. 

People with inflammatory bowel disease, regardless of whether or not they’re under control, are more likely to give birth to smaller and premature babies. However, the rate of complications seems to be higher in people with active disease at conception and during pregnancy. (Source, Source, Source)

Psoriasis

There’s no known link between psoriasis and female fertility. Having psoriasis doesn’t make it any less likely you’ll get pregnant. However, some research does show a connection between psoriasis and male fertility. (Source)

In terms of psoriasis and fetal complications there’s a lack of concrete evidence, but there may be connections between severe psoriasis and hypertensive disease development during pregnancy, as well as low birth weight and preterm birth. (Source, Source)

Multiple Sclerosis

Multiple sclerosis isn’t thought to affect fertility, but the muscle weakness and coordination issues caused by the condition can make it physically difficult to carry a child. If you have multiple sclerosis and are planning to get pregnant, you may need to visit your health care provider more often than the average person.

Delivery may also be more challenging for women with multiple sclerosis as the muscles needed for pushing may be weak. Therefore, cesarean delivery is more likely for people with the condition. (Source, Source)

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Systemic Lupus Erythematosus

In people with systemic lupus erythematosus, the condition itself is not believed to cause fertility issues. Unfortunately, medications commonly prescribed for lupus may affect fertility in the long and short term. If you’re concerned about the effects of autoimmune medications on your fertility, consult your health care professional. You should never stop taking a prescribed medication without speaking to your care provider first. 

Pregnancy can be exceptionally risky for some women with lupus, but the majority are able to have healthy pregnancies. Ideally, you should seek prenatal care from your health care team and achieve remission at least six months before you start trying to conceive. If that’s not possible, make sure your care team is involved in every step of your pregnancy, especially if you have coexisting conditions, such as high blood pressure or kidney problems. Conceiving during an active phase of lupus increases the risk of pregnancy loss and other complications. (Source, Source)

Is It Safe to Take Autoimmune Drugs While I’m Pregnant?

Your health care team can help you determine the best way to manage your medications, if you’re taking any, before and during pregnancy. Some drugs, such as methotrexate (a disease-modifying antirheumatic drug used in rheumatoid arthritis, Crohn’s, and other autoimmune disorders), shouldn’t be taken any later than three months before conception. Other disease-modifying antirheumatic drugs are considered safe for use in pregnant women. 

Starting your pregnancy with your autoimmune disease under control can significantly improve your chances of having a successful and healthy pregnancy. You shouldn’t stop taking your autoimmune medications without consulting your health care team. If your pregnancy is planned, consult your team well ahead of time so your body will have plenty of time to adjust to a new, pregnancy-friendly regimen, if necessary. (Source, Source)

Tips for a Healthy Pregnancy With an Autoimmune Condition

• Build a great care team. A care team consisting of different health care professionals, such as a primary care provider, a health coach, and a nutritional therapy practitioner, can improve your chances of having a healthy, successful pregnancy. 
• Know the risks and the signs that something may be wrong. Your risks and what’s considered abnormal for you will depend on which autoimmune condition you have and how well it’s managed. Speak to your care team about what to expect during pregnancy and after delivery. If you feel like something’s not right, don’t hesitate to seek a professional opinion.
• Don’t skip medical appointments. As a person with an autoimmune disease, you’ll likely need to see your health care providers more often than someone without. Your circumstances can change dramatically in a short time. Be sure to keep up with your medical appointments. 

The Bottom Line on Pregnancy and Autoimmune Diseases 

People with autoimmune diseases get pregnant and give birth to healthy, happy babies all the time. However, in some cases, an existing autoimmune disease may make the process of getting pregnant, and carrying and delivering a baby, more challenging. Sometimes, the changes that happen within the body in response to pregnancy can trigger an autoimmune condition in someone who didn’t have (or wasn’t diagnosed with) the condition before pregnancy. To improve your odds of getting pregnant or having a trouble-free pregnancy, you should aim to keep your condition under control and ensure your care team is involved throughout your journey. Implementing lifestyle changes that help you get your symptoms into remission allows for an increased chance at a healthy and successful pregnancy. See how WellTheory can support you in managing your condition and optimizing your health. 

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