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Antinuclear Antibodies and Pregnancy: Research Review

A short overview of the impact of antinuclear antibodies and autoimmune disease on pregnancy - and the science behind it.

April 1, 2022 Pregmune Team
Antinuclear Antibodies

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.

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About Pregmune: We’re an innovative reproductive health technology company, built on a solid foundation of data gained from decades of experience and thousands of successful pregnancies. Our team of fertility specialists and scientists are using artificial intelligence to decipher the complexity of the immune system and help patients grow the families of their dreams.

Our first product, IRMA, provides patients and their doctors with a personalized report and evidence-based treatment plan that addresses immunological sources of unexplained infertility, recurrent pregnancy loss, and recurrent implantation failure.

References

1. Giannouli E, Chatzidimitriou D, Gerou S, Gavrilaki E, Settas L, Diza E. Frequency and specificity of antibodies against nuclear and cytoplas-mic antigens in healthy individuals by classic and new methods. Clin Rheumatol. 2013; 32:1541–1546. 5.
2. Faria AC, Barcellos KS, Andrade LE. Longitudinal fluctuations of anti-bodies to extractable nuclear antigens in systemic lupus erythemato-sus. J Rheumatol. 2005; 32:1267–1272.
3. Kaider BD. Cavalcante MB, da Silva Costa F, Araujo EJr, Barini R. Risk factors as-sociated with a new pregnancy loss and perinatal outcomes in cases of recurrent miscarriage treated with lymphocyte immunotherapy. J Matern Fetal Neonatal Med. 2014; 28:1092–1096.
4.
Ticconi C, Rotondi F, Veglia M, et al. Antinuclear autoantibod-ies in women with recurrent pregnancy loss. Am J Reprod Immunol. 2010; 64:304–392.
5. Zhu Q, Wu L, Xu B, et al. A retrospective study on IVF/ICSI outcome in patients with anti- nuclear antibodies: the effects of prednisone plus low- dose aspirin adjuvant treatment. Reprod Biol Endocrinol. 2013; 11:98.
6. Cavalcante MB, da Silva Costa F, Araujo EJr, Barini R. Risk factors as-sociated with a new pregnancy loss and perinatal outcomes in cases of recurrent miscarriage treated with lymphocyte immunotherapy. J Matern Fetal Neonatal Med. 2014; 28:1092–1096.
7. Sakthiswary R, Rajalingam S, Norazman MR, Hussien H. Antinuclear antibodies predict a higher number of pregnancy loss in unexplained recurrent pregnancy loss. Clin Ter. 2015; 166: e98–e101.
8. Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum. 2006; 54:899–907.