Castro Domínguez Francisco

Recurrent pregnancy loss refers to the occurrence of two or more consecutive miscarriages before the 20th week of gestation. While the majority of pregnancy losses are due to genetic abnormalities in the fetus, autoimmune factors can contribute to recurrent pregnancy loss in some cases.

Autoimmune Factors:

Antiphospholipid Syndrome (APS) is an autoimmune condition where the immune system mistakenly produces antibodies against certain proteins in the blood. These antibodies can interfere with blood clotting and may lead to miscarriages by affecting blood flow to the placenta.

Undifferentiated Connective Tissue Disease (UCTD) is a group of heterogeneous autoimmune diseases characterized by the presence of at least one symptom of connective tissue disease accompanied by a positive test for the antinuclear antibody (ANA) and usually other specific antibodies. It is the most common autoimmune disease in pregnant women, with a prevalence of up to 2.5%. In pregnant women with Undifferentiated Connective Tissue Disease, there may be an increased risk of miscarriage and other complications.

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease that can affect various organs, including the kidneys and the cardiovascular system accompanied by a positive test for the antinuclear antibody (ANA). In pregnant women with Lupus, there may be an increased risk of miscarriage and other complications.

Thyroid Autoimmunity: Conditions such as Hashimoto's thyroiditis or Graves' disease, which involve the immune system attacking the thyroid gland, may be associated with an increased risk of recurrent pregnancy loss.

Diagnosis:

Antiphospholipid Antibody Testing blood tests, include lupus anticoagulant, anticardiolipin antibodies, and anti-beta-2-glycoprotein I antibodies.

Lupus and Undifferentiated Connective Tissue Disease testing include blood tests for specific antibodies, such as antinuclear antibodies (ANA), anti-double-stranded DNA (anti-dsDNA), Anti-Ro, anti-La and anti-RNP antibodies among others depending on patient symptoms and clinical history.

Thyroid Function Testing include thyroid hormone levels and the presence of thyroid antibodies.

Treatment:

For individuals with Antiphospholipid Syndrome, anticoagulant o antiagregant medications may be prescribed to prevent blood clots and improve pregnancy outcomes.

In cases of autoimmune conditions like Lupus or Undifferentiated Connective Tissue Disease medications to suppress the immune system may be considered to reduce the risk of miscarriage.

For individuals with thyroid autoimmunity and abnormal thyroid function, thyroid hormone replacement therapy may be recommended to achieve optimal thyroid levels.

Women with autoimmune-related recurrent pregnancy loss often require close monitoring during pregnancy, involving regular check-ups and specialized care.

Prognosis:

With appropriate management and treatment, many women with autoimmune-related recurrent pregnancy loss can have successful pregnancies.

The prognosis may vary depending on the specific autoimmune condition, its severity, and how well it responds to treatment.

Multidisciplinary Care:

Management often involves collaboration between obstetricians, rheumatologists (for autoimmune conditions), hematologists (for anticoagulant therapy), and endocrinologists (for thyroid disorders).