Pregnancy in Myositis: Challenges and Pitfalls

Over the last decade, a lot of papers have been published by scientists and clinicians in order to disseminate their knowledge about major steps accomplished in the research of autoimmune disorders and pregnancy. While pregnancy is delayed until later age in the majority of western countries and the incidence of autoimmune disorders, particularly rheumatic conditions, is increasing specifically in women of 25 to 40 years, patient’s selection for a safe pregnancy becomes a very important concern. It is essential to define a multidimensional concept that focus on how disease and its treatment affect pregnancy in autoimmune disorders. Based on values, goals and preferences of patients, physicians seem to be more critical in making decisions. Moreover, given the necessity to outline every physician’s role in the management of pregnancy and autoimmune conditions there was a strong progress toward an interdisciplinary approach comprising rheumatologists, obstetricians, endocrinologists, immunopathologists, geneticians and neonatologists. It was suggested formerly that women diagnosed with autoimmune diseases should avoid pregnancy due to excessive maternal and fetal risk, as autoimmunity can be reflected virtually on every aspect of reproduction (Borchers et al., 2010; Doria et al., 2006; Gordon, 2004; Peaceman & Ramsey-Goldman, 2008). Nevertheless, recent advances in the immunopathogenesis, assessment, monitoring and specific treatment options in patients with systemic autoimmune rheumatic disorders have resulted not only in optimal disease control, improved survival as well as quality of life, but also have been reflected in better pregnancy outcomes. As patients with autoimmune rheumatic disorders are predominantly young women at childbearing potential (between 20 and 40 years), pregnancy is a major issue with prospective interest regarding the influence of both disease and therapy on pregnancy and, conversely, the effect of pregnancy on disease outcomes (Marker-Herman & Fisher Betz, 2010; Mecacci et al, 2007). The physiological adaptation of the immune system to pregnancy (Th2-type response) potentially affects the course of the immune-mediated rheumatic conditions; equally, autoimmunity may compromise the fetal outcomes (Adams Waldorf & Nelson, 2008;