Autoimmune Disorders during Pregnancy: Effects of Biomarkers on Maternal Serum Screening and Course of Disease

Pre-existing autoimmune disease during pregnancy is infrequent occurring in 1.0-2.0% of pregnant women. Autoimmune diseases (ADs) are not lethal and can co-exist with other autoimmune types. In the present report, ADs were found to produce false positive maternal serum screens for both neural tube defects and Down syndrome. The course of ADs is highly influenced by maternal and placental proteins, hormonal factors, and cytokines. Such agents appear to serve as protective factors at the induction and effector stages of the immune response during pregnancy. During second and third trimester pregnancies and in postpartum, autoimmune-afflicted patients experience stages of remissions and relapses. Most remissions occur in the second and third trimesters when soluble immunoprotective factors attain peak levels. Some plausible immunosuppressive factors include quad biomarkers and pregnancy associated glycoproteins such as alpha-fetoprotein, human chorionic gonadotrophin, dimeric inhibin-A, and unconjugated Estriol. The mechanism of remission of ADs is not fully understood but is associated with induction of an immunosuppressive and/or immunotolerant state coincident with the presence of known and unknown soluble factors.