During pregnancy observable changes in symptoms of autoimmune diseases like Multiple sclerosis (MS), Rheumatoid arthritis (RA), SLE used to occur. eg. in some cases of RA or SLE there are improvement of symptoms in pregnancy. Why these changes occur? Is there any role of fetal cells to make these changes in symptoms?
Sir,
Autoimmune diseases are inherently unpredictable. Though there are reports of remissions occurring during gestation in Rheumatoid Arthritis, most autoimmune diseases do not improve during pregnancy. In fact, the microchimerism that results from feto-maternal cell transfer is itself implicated as a pathogenic spark in systemic sclerosis. In a significant number of cases, the disease become more fulminant during gestation, probably owing to the hormonal surges - the role of estrogen in autoimmunity has long been established.
There was consideration regarding fetal cells being the disease-modifying agent, however the conclusion was that it the immunological changes brought about by exposure of the woman to paternal HLA that differs from her own to be the probable factor that brought about disease amelioration.
This is the conclusion of a very well constructed article you might find interesting, which can be accessed via the DOI below:
"effects of Mc are pleiotropic and range from adverse to neutral or even beneficial for the host, depending upon other factors with HLA genes and the HLA relationship among cells of key importance. Fetal Mc and HLA relationships between the fetal and mother’s cells have been studied in a number of autoimmune diseases with strongest evidence implicating fetal Mc in systemic sclerosis and autoimmune thyroiditis. Maternal Mc has also been associated with autoimmune diseases in the neonate and early childhood such as NLS and T1D. Elucidating mechanisms by which naturally acquired Mc is permitted without detriment to the host may lead to novel strategies with application to prevention and treatment of autoimmune diseases."
Adams Waldorf KM, Nelson JL. Autoimmune disease during pregnancy and the microchimerism legacy of pregnancy. Immunol Invest. 2008;37(5):631–644. doi:10.1080/08820130802205886
Mediators of modified immunity in pregnancy are the polyclonal activation of B cells, the unbalanced T cell regulation in the immune response. The lupus flares up in 40 to 60% of pregnancies. This happens at every stage of pregnancy and childbirth. With little evidence, lupus occurs more often postpartum. It is recommended to plan the pregnancy with a minimum of 6 months afterflares of nephritis. Risk indicators for the mother and fetus are
- anti-Rho / La
- anti-phospholipid syndrome
- renal impairment
- hypertension.
[Tayseer, G. H., Chaudhary, P., Clowse, M.E.B.: Systemic lupus erythematosus in pregnant patients an neonatal lupus. In: Rheumatology. Ed. Hochberg, M. C. et al. Elsevier Philadelphia 2019;1208-1211.]
When people with MS understand this, they quickly say why don't you do something to create a condition like pregnancy? This question has always existed ... and is a big challenge to me
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