Autoimmune Diseases in Pregnancy
MBChB (New Zealand), PGDipObstMedGyn, FRACP (New Zealand), FAMS (Rheumatology)
Autoimmune rheumatic diseases can affect pregnancy in different ways. Below is an overview of some of the most common conditions managed by rheumatologists, how they may impact pregnancy, and the treatment approaches typically recommended.
What it is:
Lupus is a systemic autoimmune disease that causes inflammation and can affect the skin, joints, kidneys, heart, and other organs.
How it affects pregnancy:
Pregnancies in women with lupus carry a higher risk of miscarriage, preterm birth (premature babies), pre-eclampsia, lupus flares or restricted fetal growth. Women with lupus and antiphospholipid syndrome may have an increased risk of pregnancy complications. However, with close monitoring and careful pregnancy planning, many women with lupus go on to have safe pregnancies and healthy babies.
Treatment approach:
Pregnancy planning is pertinent. Ideally, lupus should be well-controlled for at least six months before conception. Some lupus medications such as hydroxychloroquine are safe to be used in pregnancy. However, there are some lupus medications that are not compatible with pregnancy. Therefore, it is important to discuss with your rheumatologist prior to conception to plan for a healthy pregnancy. During pregnancy, your rheumatologist will closely monitor your lupus disease activity.
What it is:
APS is an autoimmune disease that causes the blood to clot more easily than normal and increases the risk of pregnancy complications.
How it affects pregnancy:
During pregnancy, APS can cause miscarriage, stillbirth, blood clots, pre-eclampsia and restricted fetal growth.
Treatment approach:
Women with APS are usually treated with blood-thinners such as low-dose aspirin and heparin during pregnancy. These therapies help reduce the risk of blood clot formation and pregnancy complications. Close monitoring with regular ultrasounds and blood tests by your rheumatologist and obstetrician ensures both mother and baby remain safe throughout the pregnancy.
What it is:
RA is an autoimmune disease that primarily affects the joints, causing inflammation, pain, swelling and stiffness.
How it affects pregnancy:
RA may flare in pregnancy or after delivery. In RA, some medications are safe to continue during pregnancy, while others need to be stopped prior to planning conception. Your rheumatologist will guide you in choosing the most appropriate medications during pregnancy.
Treatment approach:
Pregnancy planning is important. Your rheumatologist will assess if your RA is well-controlled prior to planning conception. In RA, some medications can be safely continued during pregnancy while others need to be stopped before trying to conceive. Therefore, it is important to discuss with your rheumatologist to plan for a healthy pregnancy. During pregnancy, your rheumatologist will closely monitor your RA disease activity to ensure that it remains well-controlled.
What it is:
Sjögren’s Syndrome is an autoimmune disease that primarily affects the moisture-producing glands, leading to dry eyes, dry mouth, joint pains and fatigue.
How it affects pregnancy:
Sjogren’s Syndrome is associated with neonatal lupus whereby the antibodies pass from the mother to the fetus through the placenta. These antibodies can attack healthy tissues and in very rare cases may cause heart damage leading to a complication known as autoimmune congenital heart block.
Treatment approach:
Pregnancy planning is important. Your rheumatologist will assess if your Sjogren’s Syndrome is well controlled prior to planning pregnancy. Your rheumatologist will guide you in choosing the most appropriate medications during pregnancy. During pregnancy, women with Sjögren’s Syndrome will be screened with fetal echocardiography to monitor the baby’s heart rhythm.
What it is:
Vasculitis is an autoimmune condition where the blood vessels become inflamed. This can sometimes cause narrowing of the blood vessels and reduce blood flow to organs causing damage.
How it affects pregnancy:
Vasculitis can sometimes flare during pregnancy or after delivery, so close monitoring is important during this period of time. Vasculitis pregnancies are associated with an increased risk of pre-eclampsia, preterm birth (premature babies) and restricted fetal growth.
Treatment approach:
Pregnancy planning is important. Your rheumatologist will assess if your vasculitis is well-controlled prior to planning conception. In vasculitis, some medications can be safely continued during pregnancy while others need to be stopped before trying to conceive. Throughout pregnancy, your rheumatologist will monitor the vasculitis disease activity and medications are adjusted accordingly. Having early discussions with your rheumatologist will help you plan and prepare for a healthy pregnancy.
For women with autoimmune diseases, planning ahead is one of the most important steps. Pregnancy outcomes are significantly better when the disease is stable before conception on pregnancy safe medications. Patients are followed closely throughout pregnancy to maintain optimal disease control.
Key steps in pre-pregnancy planning include:
Preconception counselling: A detailed discussion with your rheumatologist to review your autoimmune disease, medications, and pregnancy goals.- Medication adjustments: Some medications used to treat autoimmune diseases are safe to continue during pregnancy, while others are not and need to be discontinued prior to conception. Your rheumatologist will recommend pregnancy compatible medications that’s appropriate for your autoimmune condition.
- Assessment of the autoimmune condition: Blood tests, urine tests, and imaging scans help assess whether the autoimmune disease is well-controlled prior to planning pregnancy.
- Collaborative care: Working closely with both your rheumatologist and obstetrician ensures that you and your baby are well supported throughout your pregnancy journey.
Postpartum Care
The weeks and months after delivery can be a vulnerable time for women with autoimmune diseases. Hormonal changes, physical recovery, and the demands of caring for a newborn may increase the risk of disease flare-ups, particularly in conditions such as lupus and rheumatoid arthritis. Careful postpartum management is essential to support the health and well-being of both mother and baby. This may include:
Regular follow-up appointments and blood tests help detect early signs of disease flares allowing prompt adjustments to treatment and reducing the risks of complications.
While some medications are safe during breastfeeding, others may need to be avoided. Your rheumatologist will guide you in choosing the safest options while maintaining disease control.
Treatment plans are tailored to maintain effective disease control with medications that are compatible with breastfeeding, if desired.
Beyond managing your autoimmune condition, postpartum care also supports physical healing, emotional well-being, healthy sleep and nutrition—all of which are important for long-term health.
Our Rheumatologist
Dr Poh Yih Jia
Senior Consultant Rheumatologist
Dr Poh Yih Jia is a dedicated rheumatologist with over 20 years of medical experience in New
Zealand and Singapore. She established the rheumatology obstetrics clinic at SGH, where she gained extensive
expertise in pre-pregnancy counselling, diagnosing and managing autoimmune rheumatic conditions in pregnancy.
Her patient-centred approach has earned her multiple accolades, including the Singapore Health Quality
Award and the Service with a Heart Award. With thoughtful planning and compassionate care, Dr Poh works to
achieve the best possible outcomes for both mother and child.
FAQs
Autoimmune rheumatic diseases are not directly inherited, but genetics can play a role in increasing susceptibility. This means your child may have a slightly higher risk, but most children of mothers with autoimmune diseases grow up healthy and never develop arthritis or other autoimmune rheumatic conditions.
Breastfeeding is usually safe for mothers with autoimmune rheumatic diseases. Most medications that are considered safe in pregnancy are also compatible with breastfeeding. Always discuss your treatment plan with your rheumatologist to ensure safety for both you and your child.
Pregnancy can affect autoimmune rheumatic diseases in different ways. Some women notice that their symptoms improve or remain stable, while others may experience flares during pregnancy or after delivery. Your rheumatologist will monitor you closely and adjust treatment as needed.
The type of delivery (vaginal or caesarean) depends on obstetric factors and your autoimmune condition. However, if your disease is active or there are pregnancy complications, your doctor may recommend additional precautions during labour and delivery to ensure the safety of both you and your baby.