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Autoimmune disorders:
More common among pregnant women
Abnormal antibodies can cross the placenta and affect the
foetus
Pregnancy affects autoimmune diseases in different ways
Most common conditions
Thyroid disease
o Graves disease
o hashimotos
ITP
Chrons disease
UC
SLE
Myasthemia gravis
RA
Thyroid
Gravess disease
o Hyperthyroidism
o Goitre
Hashimotos thyroiditis
o Chronic autoimmune thyroiditis
o Most common cause of hypo
o Gradual thyroid failure or goitre
o Autoimmune
Hyperthyroidism
o Diagnosis
TSH <0.01
Raised free T4
+/- Raised free T3
Difficult to ascertain in pregnancy
o Causes of hyperthyroidism
Graves
Gestation transient thyrotoxicosis HCG mediated
Molar pregnancy
Familial gestation thyrotoxicosis
o Increased risk of
Miscarriage
Premature labour
LBW
Still birth
Pre-eclampsia
Heart failure
Hypothyroidism
o Usually subclinical rather than overt
o PET and PIH
o Placental abruption
o Non-reassuring CTG
o Preterm delivery
o Increased risk of C/S
o PPH due to uterine atony
Thyroid peroxidase antibodies
o Increased risk of miscarriage
o Increased risk of preterm delivery
o 20% develop hypothyroidism
o May be reduced by T4 replacement
T4 therapy in pregnancy
o Hypothyroid women need more T4 in pregnancy 50%
o Aim at normalising TSH levels
o Important for foetal brain development
Post-partum thyroiditis
o Occurs in 5-10% of all pregnancies
o May occur after delivery or pregnancy loss
o May decrease milk volume
o Transient hyperthyroidism followed by transit hypo
o May recur n subsequent pregnancies
o Risk may be reduced by selenium supplements
o HF
o Hx of severe HELLP or PET
o Stroke within previous 6/12
o Recent flare in previous 6/12
Complications
o Disease exacerbating
o Miscarriage, still birth
o IUGR, low birth weight
o Drugs
Antiphospholipid antibodies
o Anti-cardiolipin
o Lupus anticoagulant
o Increased risk of miscarriage
Investigations
o Exam and BP
o RBC, renal function
o Anti-Ro/ SSA abs and anti-La/SSB abs
o LA and aCL assays
o Anti-dsDNA abs
o Complement
Complement tells us the disease activity of SLE
(goes down in more disease)
Myasthenia Gravis
Typically presents with fluctuating skeletal muscular weakness
May be ocular or generalised
May have antibodies to the AChR
Main problems is with respiratory involvement
Pregnancy
o Variable effect
o Post-partum exacerbation in 30%
o Infections can trigger exacerbations
o Steroids can cause transient worsening
o MgSO4 is contraindicated
Effect on fetus
o Trans placental passage of IgG anti-AChR
o Neuromuscular junction disorders
o Transient neonatal MG in 10-20%
o Decreased FMs and breathing
o Polyhydramnios
o Arthrogyposis multiplex congenital
Limb anomalies
Labour and delivery
o First sage not affected
o Second stage: expulsive efforts may weaken
o Assisted vaginal deliver may be indicated