With the development of Rheumatology and the improvement of detection technology, the incidence of autoimmune diseases has increased significantly. AID refers to a group of diseases in which the body produces high-titer autoantibodies and/or autoreactive lymphocytes attack the corresponding normal cells and tissues, resulting in tissue and organ damage and dysfunction involving multiple systems and organs, with diverse clinical manifestations [3]. AID is more common in women of childbearing age. On the one hand, abnormal immune function affects normal pregnancy, causing infertility, recurrent abortion and embryo termination. On the other hand, the state of pregnancy leads to the aggravation of such diseases, which directly affects the pregnancy outcome [2]. Under this condition, the interaction between the two factors affects the fetal prognosis together.
As is reported, patients with an AID history before pregnancy should prepare for pregnancy under the guidance of physicians; standardized treatment during pregnancy contributes to a better pregnancy outcome [2, 4]. For a new-diagnosed AID, there is an increased risk of fetal loss and pregnancy complications [5].In our study, nearly one-third of the patients got their diagnosis after embryo discontinuance and/or spontaneous abortion; most of them were asymptomatic and newly diagnosed. According to the "Chinese Expert Consensus on the Application of Immunosuppressants in Recurrent Abortion Combined with Rheumatology Disease," several immunosuppressants can be selected as the first choice during pregnancy, including small doses of non-fluorinated glucocorticoids, hydroxychloroquine, Salazosulfoaridine, azathioprine, tacrolimus, cyclosporine, among others [6]. For AID patients with a history of pregnancy loss or recurrent abortion, anticoagulation and antiplatelet therapy can be adopted based on the "Chinese Expert Consensus on the Prevention and Treatment of Spontaneous Abortion with low molecular weight heparin." [7, 8, 9]. Under the guidance of guidelines and consensus, the Department of Obstetrics and Rheumatology was jointly devoted to treating AID patients and achieved satisfactory pregnancy outcomes[9, 10, 11].
The increasing diagnosis of UCTD has raised significant concerns. UCTD refers to patients with certain symptoms and signs related to connective tissue disease (CTD) and serological evidence of AID but does not meet any of the established criteria for diagnosis and classification of CTD, so UCTD is also considered to be the early stage of CTD [12]. The symptoms of UCTD are mild, and symptomatic treatment is mainly foundational. During pregnancy, hydroxychloroquine and small doses of glucocorticoids are recommended to control the symptoms, resulting in successful deliveries for most patients [13, 14].
In our observation group, 30 patients (33.33%) were diagnosed with UCTD, all confirmed through early pregnancy screening. A few patients showed abnormal symptoms, including photosensitivity, morning stiffness, and facial erythema [15]. Obstetric experts recommend that preliminary anti-phospholipid antibody (aPL) screening should be carried out during the transition period (13–14 weeks) when early pregnancy transitions to middle pregnancy. Meanwhile, further autoimmune antibody detection was essential if positive, and consulting the rheumatology department was the next step [16]. For patients with a history of embryo arrest or unexpected stillbirth, it is recommended to optimize the detection of relevant immune indicators before pregnancy and found out high-risk groups for early treatment [17, 18].
Our research consistently concluded that the incidence of pregnancy complications in AID patients was significantly higher than that of the general population, with a higher rate of preterm birth [1]. However, no statistically significant associations were observed between neonatal weight and gender distribution. In addition, AID was significantly associated with a higher risk of pregnancy complications, including hypothyroidism, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy and hypertensive diseases, which may be related to immune function impairment, vascular endothelial dysfunction, proinflammatory state and metabolic abnormalities [19, 20]. Significant differences were observed in the incidence of prenatal premature rupture of fetal membranes. This can be attributed to the fact that most high-risk pregnancies were hospitalized for elective delivery, often requiring cesarean section due to the presence of precious fetuses. In contrast, most healthy pregnant women were hospitalized with labor precursors or premature rupture of fetal membranes, and their labor process followed routine procedures, resulting in a lower cesarean section rate. Therefore, psychosocial factors significantly impact the delivery of AID patients [21]. The average number of hospitalizations of AID patients was significantly higher than that of the control group. Frequent supervision and treatment during pregnancy bring certain economic pressure and mental burden to patients and their families, increasing anxiety during pregnancy, which is consistent with the research of Jessica's [21, 22].
There were several limitations to our research, including small sample size, failure to include specific immune indicators and sample bias. The prognosis analysis of patients was based on our limited clinical evidence, and long-term postpartum follow-up is necessary to assess the later outcomes of immune-related diseases [23].