Pregnancy and Sjögren's
Nancy Carteron, MD, FACR
Senior Consultant, Rheumatology Immunology
Clinical Faculty, University of California San Francisco
Most women will conceive and have healthy babies. However, there are potential complications. Consulting your obstetrician (OB-GYN), rheumatologist, and possibly a high-risk OB (perinatologist) prior to conceiving or early in pregnancy is suggested.
Factors contributing to the ability to conceive:
- Primary ovarian failure
- Environmental factors (i.e. pesticides)
Potential pregnancy complications:
- Congenital heart block (SSA/SSB
autoantibodies; possibly RNP antibodies)
- Neonatal lupus (rash)
- Fetal loss
- Intrauterine growth retardation
- Premature delivery
- Recurrent pregnancy loss
- Preeclampsia (phospholipid autoantibodies)
Know your autoantibody (blood tests) status:
Congenital heart block (CHB) – most serious potential complication:
- SSA (Ro) and SSB (La) – higher levels may carry more risk
- Phospholipid antibody (APL) – Lupus anticoagulant; IgG and IgM cardiolipin antibody; IgG and IgM anti-beta2 glycoprotein I antibody
- First pregnancy – 2 % risk
- If previous child had CHB, risk increases 10-fold for subsequent pregnancy
- Weekly Doppler fetal echocardiogram surveillance between the 18th and 24th weeks
- Cardiomyopathy can occur
- Management strategies, including fetal pacemaker available
Neonatal lupus (rash):
- Autoantibodies cross the placenta, decline over several weeks, rash resolves
- If previous child had neonatal lupus, risk increases 5-fold for neonatal rash for subsequent pregnancy
This article was first printed in The Moisture Seekers, SSF's patient newsletter for members. It is also available as an SSF Patient Education Sheet.
Pregnancy and Sjögren's,
Congenital heart block (CHB),
Sjögren’s patients, and those suffering from autoimmune disease in general, need to be cautious about their time in the sun. Ultraviolet (UV) radiation emitted from the sun and other light sources (such as some fluorescent lights) can alter immune function and lead to an autoimmune response in the body and skin.
In response to the sun, Sjögren’s patients can experience skin rashes, ocular sensitivity, pain, and disease flares. Sun sensitivity with Sjögren’s is associated with the autoantibody SSA/or Ro. Below are a few tips to help protect yourself this summer and year-round.
- Protect your skin and eyes through use of sunscreen, UV-protective lenses/sunglasses, ultraviolet light-protective clothing, hats, and non-fluorescent lighting. Sun-protective clothing is designed to protect your skin from UVA & UVB rays and is more reliable than sunscreen.
- Consider purchasing UV-protective car and home window tinting and films (which come in clear.)
- Wear sunscreen on areas not covered by sun-protective clothing, such as the neck and ears.
- Read sunscreen labels and look for the words “broad spectrum,” which protects from both UVA & UVB light. Note that the SPF ratings refer only to UVB rays.
- Use plenty of sunscreen with a higher number SPF. Most people only use about 1/3 the recommended amount of sunscreen. This reduces the benefit of the SPF rating.
- Remember to reapply sunscreen because water, humidity and sweating decrease sunscreen effectiveness.
- Investigate whether UV-protective clothing and eyewear, window shields, and sunscreens are eligible for reimbursement under your insurance plan or Flexible Health Care Spending Account.
The SSF would like to thank Mona Z. Mofid, MD, FAAD, for authoring this information that was first published in The Moisture Seekers, SSF's member newsletter, and as an SSF Patient Education Sheet.
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