THE IMPACT OF AUTOIMMUNE ENDOCRINE DISORDERS ON PREGNANCY: A COMPREHENSIVE REVIEW OF PATHOPHYSIOLOGY AND CLINICAL OUTCOMES
Main Article Content
Keywords
Pregnancy, immunological adaptation, autoimmune diseases, endocrine autoimmunity, progesterone, thyroid disorders, Hashimoto's disease, Graves' disease, postpartum thyroiditis, adrenal insufficiency, Type 1 diabetes
Abstract
Pregnancy is a transformative period characterized by extensive physiological, psychological, and immunological changes, which play a critical role in the health of both the mother and the fetus. The immune system undergoes significant modifications to tolerate the fetus, an entity resembling a temporary histoincompatible allograft, with sex hormones such as progesterone (P4) and estrogen (E) modulating these changes. This review explores the intersection of endocrine autoimmunity and pregnancy, focusing on the physiological adaptations and their clinical implications for autoimmune disorders.
The review highlights the unique role of progesterone in immune modulation, including its effects on Th1 and Th2 cell responses, and its influence on autoimmune disease activity. During pregnancy, hormonal shifts lead to immune system adaptations that often result in the remission of some autoimmune disorders but can exacerbate others postpartum. Autoimmune endocrine disorders, particularly thyroid disorders, are prevalent in women of reproductive age and significantly impact pregnancy outcomes. The review details the pathophysiology of autoimmune thyroid diseases, including Hashimoto's thyroiditis and Graves' disease, and their management in pregnant women. The risks associated with autoimmune thyroid disorders, such as miscarriage, preterm delivery, and postpartum thyroiditis, are discussed, along with guidelines for monitoring and treatment.
The review also covers autoimmune primary adrenal insufficiency (Addison's disease) and its implications during pregnancy, including management strategies and associated risks. Additionally, it addresses the challenges of managing type 1 diabetes in pregnant women, emphasizing the importance of preconception care and ongoing management throughout pregnancy to optimize maternal and fetal outcomes.
In summary, this article provides a comprehensive overview of the interplay between endocrine autoimmunity and pregnancy, offering insights into the physiological, pathophysiological, and clinical aspects of managing autoimmune endocrine disorders during this critical period.
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Aiysha Gul
Department of Obstetrics and Gynaecology, Mardan Medical Complex, Pakistan
Rizwanullah
Department of Medicine, Hayatabad Medical Complex, Pakistan
Samah Badr Hamad
Department of Basic Medical Sciences, University of Khartoum, Sudan
Esraa Awad
Department of Medicine, Zagazig University Hospitals, Egypt
Fardin Akbar Hyderi
Department of Medicine, Bangladesh Medical College, Bangladesh
Giftty E. Obadan
Department of Medicine, Philadelphia College of Osteopathic Medicine, USA
Karthiga Vasudevan
Department of Medicine, Yerevan state medical university, Armenia