Pregnancy and Autoimmune Disease: A Functional Medicine Approach to a Healthy Pregnancy
A lot of our female patients ask us how pregnancy will affect their autoimmune disease and what will happen with their rheumatoid arthritis or lupus after pregnancy. They want to know if their autoimmune condition will get better or worse when they’re having a baby.
In this blog post, we’ll talk about pregnancy and autoimmune disease and what you can expect. But to understand what’s going to happen while you’re pregnant, first, we must look at how the immune system normally changes during the menstrual cycle. After that, we’ll discuss autoimmune flare-ups during and after pregnancy and how to manage them.
How the Menstrual Cycle Affects a Woman’s Immune System
Even before you get pregnant, there are hormonal fluctuations that can affect your immune system. This is why the menstrual cycle can affect women with autoimmune disease. There’s a direct relationship between hormones and the immune system. In menstruating women, shifts in the immune system happen in response to fluctuation of hormones. For example, in the follicular phase, the first half of the menstrual cycle when the ovaries are preparing to release an egg, estrogen is more the dominant hormone. At the same time, progesterone levels are low.
Women’s immune systems are in more of a Th1 dominant state in the first half of their cycle. In this type of state, T helper cells type 1 (Th1) are more active than other types of T helper immune cells. Estrogen can stimulate the activity of the Th1 immune cells that help us fight off pathogens, which prevents us from getting sick.
Then during the second half of our cycle, from ovulation to your next period, there’s a shift in the immune system with a rise of progesterone, which shifts the immune system more towards a Th2 dominant state. A Th2 state decreases the activity of immune cells that were dominant in the first half of the cycle. It does this because the body is preparing to potentially get pregnant, and when a woman gets pregnant it’s important that the body does not perceive the baby as a foreign harmful substance.
A few days before and during a woman’s period, both estrogen and progesterone levels drop and there’s a rise in inflammatory chemicals called prostaglandins. During this time of increased inflammation, women with autoimmune disease often have more flares.
It becomes more complicated in autoimmune patients if they tend to be more estrogen dominant all the time and their progesterone is low. Estrogen dominance is a hormonal imbalance where estrogen is the dominant signal overpowering progesterone signals.
Even without pregnancy in the picture, women with autoimmune disease need to help the immune system function better throughout their cycle. But when a woman gets pregnant, there’s a downshift in the immune system in order to preserve and protect the fetus. The immune system has to take a backseat so that it doesn’t confuse the baby for an invading pathogen and mistakenly attack it.
Do Autoimmune Conditions Get Better or Worse During Pregnancy?
Many women, but not all, get relief of their autoimmune symptoms during pregnancy. Why? During pregnancy, a couple of things happen with the immune system. We shift from that Th1 state of increased immunity to a Th2 state of decreased immunity. This is why pregnant women are more prone to getting sick. What’s more, a woman’s T-reg cells increase during pregnancy. For women with autoimmunity, this is a good thing because T-reg cells prevent the destruction of tissue and excessive inflammation that are common in autoimmune conditions. The shift in the immune system combined with the increase in T-reg cells that occurs during pregnancy is why certain autoimmune conditions get better during pregnancy. Rheumatoid arthritis and pregnancy is one example. Multiple sclerosis is another example of an autoimmune condition that tends to get a lot better during pregnancy.
But there are other conditions like lupus that have more of a tendency to flare or get worse during pregnancy. It’s not a black and white issue where you’re definitely going to get better during pregnancy or if you have lupus, you’re going to get worse. It comes down to the individual and all the factors and underlying root causes of her autoimmune disease as a whole.
Another factor to consider is women who have rheumatic problems like joint and muscle issues. During pregnancy, certain hormones create more looseness in the body during pregnancy and that can make joint problems worse. More lax ligaments and tendons can create more potential for joint injury.
Even though we have to consider those other factors, generally, I find that most pregnant women with an autoimmune disease do feel better during pregnancy and they kind of go into a remission state during this time.
Another reason women with autoimmune disease may feel better during pregnancy is because cortisol levels are elevated during pregnancy and can stay high for a while after delivery, sometimes as long as two or three months. Cortisol is anti-inflammatory, so that can be helpful for a lot of women. It can boost energy levels, but it also can do things like raise blood sugar. That’s why higher cortisol during pregnancy can be either triggering or helpful for some women.
Post-Pregnancy Autoimmune Flare-Ups
After delivery, the immune system changes again and it tries to reset to the normal fluctuations that it had in its pre-pregnancy state, which can take a while. These postpartum fluctuations also can lead to flare-ups, especially as a woman’s body shifts back into a Th1 state.
A common issue that happens after pregnancy is postpartum thyroiditis. It’s really common that we see Hashimoto’s thyroiditis antibodies after pregnancy. Hashimoto’s is an autoimmune condition that affects the thyroid gland. It is characterized by high thyroid antibodies in blood, signaling that the immune system is attacking the thyroid. Thyroid function can take 12 to 18 months postpartum to normalize.
Hormonal recovery from pregnancy and full normalization of menstrual cycles can take up to a year postpartum and can take even longer if a woman is breastfeeding because breastfeeding suppresses estrogen.
A lot of times, if a woman’s feeling really good during pregnancy, we have to prepare her for having a flare up in the months afterwards. Rheumatoid arthritis, lupus, and MS flares typically occur in the three to six-months after giving birth. We want to prepare for that and be mindful of all the things that contribute to flares as a whole. We can’t always control our hormone levels during this time because our body is doing the best it can to try to normalize things. But what we can do is pay attention to other factors that we can control that also trigger the immune system (more on this later).
One other postpartum problem is the physical demand of carrying a baby all the time, which can cause flare ups in the musculoskeletal system such as the joints. This happens because there has been so much change in those tissues during pregnancy. I remember having a lot of neck, shoulder, and back pain carrying around a baby and toddler for a while. Changes to body weight during and after pregnancy can also strain muscles and joints.
Stopping Autoimmune Flare-Ups Before and After Pregnancy
The best-case scenario is when we can work with a woman with autoimmunity before she gets pregnant, during the preconception period. This way the mother-to-be has identified and removed her triggers, built up her nutrition, balanced her microbiome, and calmed down inflammation. She has the specific tools to help with her autoimmune condition- even before pregnancy.
During pregnancy and breastfeeding, only natural and safe treatments should be used to prioritize the health of the baby, when possible. There are still many natural options to help manage autoimmune symptoms during flares. However, there are some treatments we cannot easily use when a growing baby is part of the equation. Good choices include omega-3s, vitamin D3, glutathione, turmeric/curcumin, and a prenatal multivitamin.
After the baby is born, you can reduce your risk of autoimmune flares. Rather than trying to balance hormones when a woman’s body is trying to get back into its natural state, I recommend that women work on aspects of their health they have more control over. When you’re a new parent, you’re not getting enough sleep, there’s extra stress, you’re not taking care of yourself as well as you would like. All of those factors are potential triggers for autoimmune flares.
Be sure to schedule in some self-care time and make sure you’re taking care of the basics such as getting sleep, staying hydrated, and eating enough nutritious food.
For more specifics on taking care of yourself before and after pregnancy , I recommend the following resources:
• Aviva Romm, MD: Integrative MD and midwife with fantastic, evidence-based resources for pregnancy, birth, herbal medicine, and women’s health. Covers topics like natural labor prep, prenatal nutrition, and preventing Group B Strep naturally.
• Mama Natural: Popular site for natural-minded moms with week-by-week pregnancy updates, birth prep guides, baby name ideas, and clean product reviews. Great mix of research and practical mama advice.
• Evidence Based Birth: Research-backed articles on common birth interventions, prenatal testing, and labor practices. Ideal for expecting moms who want to advocate for themselves with science in hand.
• Lily Nichols, RDN: Dietitian who wrote Real Food for Pregnancy — her site includes free resources and blog posts on prenatal nutrition, gestational diabetes, and micronutrients. Great for health-conscious moms who want optimal nutrition guidance.
Relying on friends, family, and your spouse as sources of support is important. I had two children under two. I had my second child when my first was 17 months. I was taking care of two babies at once. We had family help and stay with us for a while so that I could have some recovery time.
I also find that the women who stay on prenatal vitamins or postnatal vitamins during that period tend to do better because they’re getting that extra nutritional support from their supplements.
Preparing for Pregnancy with an Autoimmune Condition
At the Caplan Health Institute, many of our female practice members with autoimmune conditions want to know how they can prepare for pregnancy. The answer is going to be slightly different for every woman, which is where we can help.
The first step is to schedule a free 15-minute discovery consultation, by phone or video. If you decide to come on board as a practice member we’ll work with you to ensure that you and your baby are healthy and happy. We call our clients “practice members,” rather than patients, due to the active role they take in their healing. We can guide you through all the transitions that occur during and after pregnancy, so you’ll know what to expect and what you can do about any flare ups that occur.
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