Endocrine Autoimmunity in Pregnancy

Frontiers in Immunology

Krzysztof Sworczak¹  Renata Świątkowska-Stodulska¹  Agata Berlińska¹  Elżbieta Andrysiak-Mamos²  Joanna Połom³  Piotr Wydra⁴  Maciej Zieliński⁴  Sebastian Kwiatkowski⁵  Katarzyna Stefańska⁶ 

[1] Department of Endocrinology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland;Department of Endocrinology, Metabolic Diseases and Internal Diseases Pomeranian Medical University, Szczecin, Poland;Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland;Department of Medical Immunology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland;Department of Obstetrics and Gynecology, Pomeranian Medical University of Szczecin, Szczecin, Poland;Division of Gynecology and Obstetrics, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland;

关键词: Hashimoto’s disease;    Hashimoto’s thyroiditis;    Graves’ disease;    postpartum thyroiditis;    autoimmune thyroid disorder;    Addison’s disease;   

DOI  :  10.3389/fimmu.2022.907561

来源: DOAJ

【 摘 要 】

Human gestation leads to a number of physiological alterations which peak at the development of placentta known for, among many other functions, being a transient but highly potent endocrine organ. Hormonal activity of placenta is marked by its ability to continuously produce and secrete high levels of progesterone. Progesterone guards the well-being of the fetoplacental unit throughout the gestation and one of the proposed mechanisms of this principle involves the development of local and systemic immune tolerance mainly due to impediment of CD4+ lymphocyte activation. However, though these alterations are present and well-established, autoimmunity is not entirely rare and a wide spectrum of diseases can continue, or develop de novo, throughout the gestation or even after the delivery. Up-to-date data supports the existence of a relationship between the clinical course of chosen autoimmune diseases and levels of circulating sex steroids.The most common autoimmune endocrinopathies in pregnant women are Hashimoto’s disease, Graves’ disease, and, more rarely, primary adrenal insufficiency in the form of Addison’s disease. Gestation can influence the clinical course of these endocrinopathies in patients who were diagnosed before conception. Multiple particles, like TSH-receptor stimulating antibodies, thyroid hormones, glucocorticoids, and anti-thyroid medications, can cross the placental barrier and evoke biological action in fetal tissues. Thyroid pathology in the form of postpartum thyroiditis is particularly prevalent in patients with positive anti-thyroperoxidase and anti-thyroglobulin antibodies. Certain populations are more at risk of developing numerous gestational complications and require regular follow-up. In our paper, we would like to address physiological, physiopathological, and clinical aspects of endocrine autoimmunity throughout human gestation, as well as special circumstances to consider in pregnant women.

【 授权许可】

Unknown