Antinuclear Antibodies and Pregnancy: Research Review

The nucleus of a cell contains DNA and diverse proteins required to keep the cell functioning. Sometimes, a person’s immune system will begin to attack proteins in the nucleus by developing antinuclear antibodies (ANAs). When present in high concentrations, ANAs could indicate an autoimmune disease such as lupus.

Many autoimmune diseases can raise a patient’s chances for adverse pregnancy outcomes, which is why expectant mothers with antiphospholipid syndrome, lupus, rheumatoid arthritis, and other autoimmune disorders are considered high-risk pregnancies. However, many people remain undiagnosed for autoimmune conditions.

Physiology

Antinuclear antibodies are autoantibodies targeting “normal” proteins within the nucleus of your cells.
The presence of ANA antibodies in small amount may not be a sign for autoimmune diseases¹ and can fluctuate over time².

Nevertheless, large titers can indicate an autoimmune disease such as lupus, scleroderma, juvenile arthritis, autoimmune hepatitis, autoimmune thyroid disease or Sjögren’s syndrome.

Published clinical data

ANA may play a role in early pregnancy as well as in reccurent pregnancy losses (RPL) by negatively impacting embryo development³.

ANA have been detected more frequently in women with RPL than in control women⁴. They are also associated with poor outcomes of IVF/ICSI cycles⁵. ANA positivity may predict a subsequent miscarriage⁶ in women with RPL. Indeed, ANA+ RPL women had a higher number of miscarriages and lower number of successful subsequent pregnancies than ANA− women⁷.

It is important to note that miscarriages occurred in women positive for ANA+ before pregnancy and who remained ANA+ in the first trimester.

Pregnancy in RA patients is associated with higher risk for complications such as IUGR (intra uterine growth retardation) and premature rupture of membranes with rates that are 1.5–2 times higher than in the general obstetric population⁸.