In October, Chrissy Teigen and John Legend shared the tragic news of the loss of their infant during delivery. Many women/ couples go through this devastating loss and it is not often spoken about publicly.
I just wanted to talk about pregnancy loss in women with autoimmune diseases.
Individuals with autoimmune diseases such as lupus, rheumatoid arthritis and Diabetes do have increase risk of infertility. Women with Lupus have an increased risk of recurrent miscarriage, pre-term labor, preeclampsia and stillbirth.
Medications sued to treat RA can result in teratogenic or birth defects as well as preterm labor.
Women with scleroderma are also at risk for developing preeclampsia which can result in preterm labor.
Recurrent miscarriage occurs in about 1% of the general population when trying to conceive. The risk of fetal loss is higher in women with active lupus or lupus nephritis. Approximately 10-15% of women with recurrent miscarriage are diagnosed with antiphospholipid syndrome.
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by blood clots within the arteries, veins and different organs. It can lead to miscarriage and stillbirth in pregnant women. Often when recurrent miscarriages occur more than 10 weeks of gestation, this condition is often considered.
The diagnosis of APS should be considered/made with 3 or more consecutive losses without another cause.
APS has other obstetric complications:
- Early delivery
- Placental insufficiency
- Intra-uterine growth restriction
- HELLP syndrome (hemolysis, elevated liver enzymes and low platelets
Neonatal complications include fetal distress, prematurity especially in lupus patients and intrauterine growth restriction
In this condition there are antiphospholipid antibodies (aPL) that are present and can be seen in other diseases like lupus and connective tissue diseases. The autoantibodies include
- Anti-B2 glycoprotein
- Lupus anticoagulant
The two greatest risk factors for fetal loss are a history of previous miscarriage and high titer anticardiolipin IgG. IgM also has increased risk of miscarriage as well as presence of lupus anticoagulant,
Every woman with APS should have pre-pregnancy counseling that focuses on the risks of maternal clots, fetal loss (early and late term) as well as placenta mediated complications including pre-term delivery.
A maternal fetal medicine specialist and hematologist must be involved.
Women would need to be on a therapeutic dose of low-molecular weight heparin (LMWH) before or very shortly after conception.
Low dose aspirin may also help reduce the risk of preeclampsia and other complications.
Coumadin (warfarin) another blood thinner is not used during pregnancy and not recommended due to teratogenic effects to the fetus.
For women with lupus, hydroxychloroquine (Plaquenil) is sometimes used and has mild antithrombotic effects.
I want to take a moment to honor all those who have lost a child during pregnancy or infancy. I empathize with you. It is important to take the necessary time to grieve, recover and heal. Although the loss is never forgotten, know that there are people to support you to help find peace eventually.
You are not to blame. Take care of yourself physically and emotionally.
Everyone grieves differently.
That child is never forgotten and will live in your memory forever.
With love, Dr. Maggie
Additional Information on APS
There is Primary APS- (without lupus association) and Secondary (with lupus)
Other Labs positive in APS
- False positive test for syphilis
- Antiprothrombin antibodies
- Antiphophatidylserine antibodies
Antiphospholipid antibodies can also be stimulated by infection ( syphilis, Lyme disease, Epstein Barr virus, CMV virsus)
It can also be seen with some drugs and also seen in the general population.
Other clinical manifestations of APS
- Skin- Lacy rash called Livedo reticularis, ulcerations, gangrene in digits
- Kidney- Nephropathy (proteinuria), Renal infarct
- Veins- DVT (leg clot) Pulmonary embolism (clot in lung), Clot in heaptic or renal vein
- Arteries- Stroke, Heart attack
- Heart- Mitral valve, aortic valve problems
- Avascular necrosis- (dead bone or diminished supply to bone)
- Neurologic- seizures, Multiple sclerosis like syndrome
- Low platelets, hemolytic anemia
Dr. Faucci has been with the nation for the past few months supporting us and trying to guide us through this pandemic.
I’ve said this before, and I’ll say it again.
I stand with Science and the evidence-based facts.
I stand with my fellow healthcare professionals, physicians, pharmacists, scientists, researchers, nurses and ANY practitioner and essential employee in medicine.
The people in the healthcare profession CARE about what happens to you.
Dr. Fauci has spent his entire career dedicating his efforts to help heal people and deliver the essential information we need to make informed decisions about our health.
I watched him and ALL of the scientists/clinicians and former CDC directors band together to try and advocate social distancing, mask wearing, hand washing and the use of hand sanitizers while analyzing the daily scientific data in order to ensure that this pandemic eventually comes to an end.
Their input matters. Science matters.
We all have our part to play.
I use my mask every day in the office as well as an antimicrobial gown to keep me protected.
I wash my hands.
I maintain my distance from others whoa re not in my bubble or cohort.
I use hand sanitizer when I am unable to do handwashing.
I got my flu shot!
We need to protect the medical professionals that are sacrificing their health daily to ensure that we live and beat this virus!
Science is also here to Protect EVERYONE.
Now we need to keep doing our part.
We need to protect ourselves so we can protect others.
Support the scientists. Leave the negativity behind.
WEAR YOUR MASK!