What is Sjögren syndrome during pregnancy?
Sjögren syndrome is an autoimmune condition in which the immune system attacks fluid-producing glands, especially salivary glands and tear glands. This leads to dry mouth (xerostomia) and dry eyes (xerophthalmia). The significance of Sjögren syndrome for pregnancy is that sometimes the antibodies produced by the immune system in the disease process can cause problems for the baby.
How common is Sjögren syndrome during pregnancy?
Sjögren syndrome is reported to be present in 0.1 to 4.8 percent of people, but it strikes women nine times as much as men and affects women mainly in their thirties. These factors, plus the fact that women have been getting pregnant for the first time at older ages than in the past, may explain a growing rate of pregnancies in women with Sjögren syndrome.
How is Sjögren syndrome during pregnancy diagnosed?
Initial clues that you may suffer from Sjögren syndrome come from the main symptoms, namely dry mouth and dry eyes. Your mouth may feel so dry that it is difficult to swallow or speak, while your eyes may feel burning, gritty, or itchy. Additional symptoms that may occur include cough, swollen salivary glands, dry skin, vaginal dryness, skin rash, and joint swelling or pain. Your eyes will be examined by an ophthalmologist who will check for drying and signs of damage from drying and also perform whats called the Schirmer tear test, which measures the amount that the eyes are able to tear. The laboratory workup of your blood samples will include a complete blood count (CBC), a comprehensive metabolic panel (CMP, sometimes called a chem-14), tests for markers of inflammation (erythrocyte sedimentation rate [ESR], C reactive protein, tests for anti-SS-A (anti-Ro) and anti-SS-B (anti-La) antibodies2, and a range of tests to determine whether your symptoms are due to primary Sjögren syndrome (pSS) as opposed to being part of another rheumatological condition that includes Sjögren effects. For the same reason, various laboratory tests will be conducted to evaluate organs other than the eyes and salivary glands. Additionally, special imaging tests will be conducted of the salivary glands, from which doctors may also take a biopsy for examination under a microscope.
Does Sjögren syndrome cause problems during pregnancy?
Sjögren syndrome gives you dry mouth and dry eyes. Your mouth may feel so dry that it is difficult to swallow or speak, while your eyes may feel burning, gritty, or itchy. Additional symptoms that may occur include cough, swollen salivary glands, dry skin, vaginal dryness, skin rash, and joint swelling or pain. Various other problems also have associations with Sjögren syndrome, including irritable bowel syndrome, lung infections, and Raynaud phenomenon, characterized by numbness and pain in the hands when exposed to the cold. Sjögren syndrome also is associated with an elevated risk for developing a type of cancer called non-Hodgkin lymphoma.
Does Sjögren syndrome cause problems for the baby?
Sjögren syndrome causes your immune system to produce antibodies that can reach the baby, causing a skin rash and congenital heart problems.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the Sjögren syndrome
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat Sjögren syndrome during pregnancy?
Sjögren syndrome is often treated with medications that inhibit inflammation, such as cyclosporine, in the form of eye drops. While the jury is out on whether this medication can be harmful to the fetus when a mother takes it internally, it is unlikely that the medication would affect the baby when given as eye drops. The same is true for another eye drop medication called lifitegrast. Outside of pregnancy, women with the condition are often given an immunosuppressive medication called methotrexate, but this must be avoided during pregnancy as it can harm the fetus. To promote salivation and tearing, there is a drug called pilocarpine that is given sometimes in those with Sjögren syndrome, but there are questions about its safety in pregnancy.
Who should NOT stop taking medication for Sjögren syndrome during pregnancy?
If you are taking eye drop medication that is helping against your symptoms, there is little reason to stop the treatment while you are pregnant. If you are taking pilocarpine internally, your doctor may advise you to stop, and if you are taking methotrexate, this treatment must stop until you have delivered.
What should I know about choosing a medication for my Sjögren syndrome during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my Sjögren syndrome when I am breastfeeding?
Cyclosporine eye drops are not thought to present an issue for breastfeeding, but there is concern about pilocarpine entering breastmilk, even if you take it in the form of eye drops. Uncertainty and controversy surround the question of methotrexate in the setting of breastfeeding.
What alternative therapies besides medications can I use to treat my Sjögren syndrome during pregnancy?
Dry eyes of Sjögren syndrome can be treated with a minor surgical procedure in which tear ducts are plugged to keep them from draining tear fluid from the eyes. Other helpful measures include increasing your consumption of fluids and chewing gum to stimulate saliva flow. Special mouthwashes are available to confront dry mouth as well, plus there are artificial tear drops that you can use. Avoid smoking.
What can I do for myself and my baby when I have Sjögren syndrome during pregnancy?
Follow the instructions of your physician. Be assured that there are treatments available to mitigate your symptoms.
Resources for Sjögren syndrome in pregnancy:
For more information about Sjögren syndrome during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:
General information
It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.
For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.
It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.
If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.
If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.
Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.