Review
Interaction of pregnancy and autoimmune rheumatic disease
Monika Østensen
⁎
, Peter M. Villiger, Frauke Förger
Department of Rheumatology and Clinical Immunology and Allergology, University Hospital, Bern, Switzerland
abstractarticle info
Available online 2 December 2011
Keywords:
Pregnancy
Immune response
Disease onset
Rheumatoid arthritis
Systemic lupus erythematosus
Ankylosing spondylitis
During pregnancy, the fetus represents a natural allograft that is not normally rejected. While the maternal
immune system retains the ability to respond to foreign antigens, tolerance mechanisms are up-regulated
to protect the fetus from immunologic attacks by the mother. The profound immunologic adaptations during
and after pregnancy do influence maternal autoimmune rheumatic diseases in several ways. One is triggering
the onset of a rheumatic disease in the post partum period, the other influencing disease activity of estab-
lished rheumatic disease.
The review will discuss the mechanisms of increased susceptibility of rheumatoid arthritis (RA) in the first
year post partum with a specific emphasis on the role of fetal cells or antigens persisting in the maternal cir-
culation (so called microchimerism). Furthermore, the different influences of pregnancy on established rheu-
matic diseases will be highlighted. A marked beneficial effect of pregnancy is observed on RA whereas several
other rheumatic diseases as ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE) show either
no p]articular effect or an aggravation of symptoms during pregnancy. Differences emerging in regard to
modulation of disease symptoms during pregnancy seem related to response to hormones, the type of cyto-
kine profile and immune response prevailing as well as further downstream interactions of molecular path-
ways that are important in disease pathogenesis.
© 2011 Elsevier B.V. All rights reserved.
Contents
1. Introduction .............................................................A437
2. Onset of arthritis ...........................................................A438
3. The influence of pregnancy on established rheumatic disease .......................................A439
3.1. Rheumatoid arthritis ......................................................A439
3.2. Ankylosing spondylitis .....................................................A439
3.3. Systemic lupus erythematosus ..................................................A439
4. The immune response in pregnancy ...................................................A439
4.1. Circulating cytokines ......................................................A440
5. The immune response during pregnancy in healthy and diseased rheumatic women: presentation of own studies ..............A441
5.1. Genes and pathways in PBMC ..................................................A442
6. Aspects of different responses of rheumatic disease to pregnancy .....................................A442
6.1. SLE ..............................................................A442
6.2. AS ...............................................................A443
7. Conclusion...............................................................A443
Disclosure .................................................................A443
References .................................................................A443
1. Introduction
Pregnancy induces dramatic immune and neuroendocrine alter-
ations in the maternal body in order to protect the fetus from immuno-
logic attack by the mother [1]. Instead of a general immunosuppression
Autoimmunity Reviews 11 (2012) A437–A446
⁎ Corresponding author at: Department of Rheumatology and Clinical Immunology
and Allergy, University Hospital, CH-3010 Bern, Switzerland. Tel.: +41 47 38 398707.
E-mail address: monika.ostensen@gmail.com (M. Østensen).
1568-9972/$ – see front matter © 2011 Elsevier B.V. All rights reserved.
doi:10.1016/j.autrev.2011.11.013
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Autoimmunity Reviews
journal homepage: www.elsevier.com/locate/autrev