Previous literature evidence has shown that hormonal factors linked to reproductive status are involved in regulating the onset of various autoimmune diseases. Now, a prospective cohort study published in the November 2022 issue of Rheumatology has concluded that pregnancy-associated hormonal modifications may lead to the worsening of preclinical rheumatic disorders and their subsequent progression to a definite rheumatic disease.
The five-year follow-up study conducted by Beneventi et al. involved 208 first-trimester pregnancy subjects with symptoms and laboratory findings indicative of an underlying autoimmune disorder. Progression towards a definite autoimmune disease was noted in 48% of the women with one or more subsequent viable pregnancies compared to 25% with no subsequent pregnancies (Adj.OR = 4.9,95%). The study has also observed the key role of preeclampsia during the index or subsequent pregnancies as an independent risk factor for progression to a definite autoimmune disease (Adj.OR = 4.3,95%).
Wilder et al. have provided substantial evidence to corroborate that changes in the pregnancy-related hormones namely cortisol, progesterone and estrogen play a significant role in Th1/Th2 cytokine balance modulation. The researchers have noted suppression of cell-mediated immune function and Th1 cytokine production during pregnancy, as well as the enhancement of humoral immunity.
The present study also clarifies the increased propensity of autoimmune diseases noted among women. Further studies in this direction may help in developing novel therapeutic strategies to regulate the hormonal factors linked to the development of autoimmune diseases.
- Beneventi F, Bellingeri C, De Maggio I, Cavagnoli C, Boschetti A, Giannico S, et al. Impact of pregnancy on progression of preclinical autoimmune disorders: a prospective cohort study. Rheumatology. 2022 Nov 7;keac637.
- Wilder RL. Hormones, pregnancy, and autoimmune diseases. Ann N Y Acad Sci. 1998;840:45-50.