Pregnancy Loss and Autoimmune Disease
Antiphospholipid syndrome and lupus can raise the risk of miscarriage. What to know about diagnosis, treatment, and grieving with compassion.
I want to talk about pregnancy loss in women with autoimmune diseases. Recurrent miscarriage occurs in about 1 percent of the general population trying to conceive, but the risk of fetal loss is higher in women with active lupus or lupus nephritis. About 10 to 15 percent of women with recurrent miscarriage are diagnosed with antiphospholipid syndrome (APS).
APS is an autoimmune disease characterized by blood clots in the arteries, veins, and organs, and it can lead to miscarriage and stillbirth. It is often considered when recurrent miscarriages occur after 10 weeks of gestation. Other obstetric complications include preeclampsia, eclampsia, intrauterine growth restriction, and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).
In APS, antiphospholipid antibodies are present and can also be seen in lupus and other connective tissue diseases; these include anticardiolipin, anti-beta-2 glycoprotein, and lupus anticoagulant. Every woman with APS should have pre-pregnancy counseling covering the risks of maternal clots, early and late fetal loss, and placenta-related complications, with a maternal-fetal medicine specialist and hematologist involved.
Treatment typically involves a therapeutic dose of low-molecular-weight heparin before or shortly after conception, and low-dose aspirin may reduce the risk of preeclampsia. Warfarin (Coumadin) is not used in pregnancy due to harm to the fetus. For women with lupus, hydroxychloroquine (Plaquenil) is sometimes used and has mild antithrombotic effects.
I want to honor everyone who has lost a child during pregnancy or infancy. Please take the time you need to grieve, recover, and heal. You are not to blame. Everyone grieves differently, and although the loss is never forgotten, there are people to support you as you find peace. That child will live in your memory forever.
Dr. Maggie Cadet, MD