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Pregnancy and autoimmune diseases

Pregnancy during an autoimmune or autoinflammatory disease is not contraindicated, it is anticipated, ideally from the preconception period onwards. The questions arise before conception: disease activity, organ involvement, immunological profile, current treatments, obstetric history. The work in which Arsène Mekinian has taken part concerns some of these situations, Takayasu arteritis, autoinflammatory diseases, systemic sclerosis, antiphospholipid syndrome and the outcome of children exposed to certain maternal autoantibodies.

This page describes work and open questions. It states no course of drug treatment, does not replace medical advice, and refers for each disease to the corresponding substantive page.

Pregnancy during an autoimmune or autoinflammatory disease calls for a specific approach, ideally anticipated from the preconception period onwards.

The main issues are to assess disease activity, organ involvement, the immunological profile, current treatments and obstetric risk factors, and then to organise monitoring suited to the whole of the pregnancy and the postpartum period.

The work in which Arsène Mekinian takes part concerns in particular vasculitis, autoinflammatory diseases, systemic sclerosis, antiphospholipid syndrome and the consequences of fetal exposure to certain maternal autoantibodies.

An interaction in both directions

Pregnancy brings about substantial immunological, cardiovascular and metabolic adaptations liable to interact with a pre-existing systemic disease. This balance does not shift in the same direction for all diseases: some settle, others reawaken, others do not move.

Conversely, the activity of an autoimmune disease, certain vascular, cardiac or renal involvements, previous arterial hypertension and certain autoantibodies may influence the course of the pregnancy, the growth of the fetus and the term of delivery.

The risk therefore depends less on the diagnosis alone than on the individual phenotype of the disease at the time the pregnancy is planned. This approach leads to pregnancy being considered as a course comprising three closely linked periods: preconception, pregnancy and postpartum.

Two further points structure the subject. First, some of the mother's antibodies cross the placental barrier and may reach the fetus or the newborn, independently of the mother's condition: this is the case for antiphospholipid antibodies and for anti-SSA antibodies. Second, the question of drugs arises before conception rather than after, because certain background treatments must be reassessed well in advance.

Preparing for pregnancy

The preconception period is a central stage of care. It makes it possible in particular to assess:

  • the activity and the stability of the disease;
  • the organ involvement liable to influence the pregnancy;
  • the autoantibody profile;
  • the obstetric and thrombotic history;
  • the compatibility of treatments with conception, pregnancy and breastfeeding.

The aim is to anticipate situations at risk and, where necessary, to adapt treatment before conception rather than during the pregnancy.

The international survey in which he took part, published in 2023 in the Journal of Rheumatology, gives a measure of what referral centres do in this respect: a pre-pregnancy counselling consultation was offered routinely by 96% of the 69 centres surveyed in 21 countries, whereas the number of consultations during pregnancy varied from one centre to another 9. The other results of this survey appear below.

Autoantibodies and pregnancy

Certain maternal autoantibodies may be of particular importance during pregnancy.

Antiphospholipid antibodies are associated with thrombotic and placental complications and define, in an appropriate clinical context, antiphospholipid syndrome.

Anti-SSA/Ro and anti-SSB/La antibodies can cross the placenta and warrant a specific assessment of fetal risk. He signs in 2019, in Joint Bone Spine, a French single-centre retrospective study on obstetric morbidity related to anti-SSA antibodies. This work was published in the form of a two-page letter, whose MEDLINE record carries no abstract: neither the numbers, nor the period, nor the results are accessible at source, and this page therefore cites no figure from it. The keywords of the record indicate that the question asked brought together anti-SSA antibodies, Sjögren's syndrome and antiphospholipid syndrome. He is last named author and corresponding author 7. This is the only work that connects him directly to maternal antibodies at risk for the fetus, apart from antiphospholipid antibodies, and its content remains to be obtained. The link between anti-SSA antibodies and congenital atrioventricular block is not written on this page: it is established by none of his publications read at source. Cutaneous neonatal lupus, for its part, is observed and reported in his 2013 study on the outcome of children, described below 2.

The interpretation of these antibodies must always be integrated into the clinical context: their presence alone summarises neither the maternal risk nor the obstetric prognosis.

He also co-signs, in 2013, a one-page note in La Revue du praticien on pemphigoid gestationis, an autoimmune skin disease specific to pregnancy; the record carries no abstract and the content could not be read. He is 4th of 5 named authors there 3.

Pregnancy and vasculitis

Systemic vasculitides require an individualised assessment taking account of inflammatory activity and vascular sequelae.

The French work on Takayasu arteritis in which Arsène Mekinian took part constitutes his most documented work on pregnancy in a vasculitis. The French retrospective study published in 2020 in Clinical Rheumatology brought together all the pregnancies of women with a diagnosis of Takayasu arteritis in twenty French hospitals up to August 2015, that is 43 pregnancies in 33 women, of whom 29 with a diagnosis already made and 4 diagnosed during the pregnancy. Complications were observed in 20 pregnancies (47%): arterial hypertension in 35% of cases (n = 15), pre-eclampsia in 9% (n = 4), HELLP syndrome in 2% (n = 1) and intrauterine growth restriction in 14% (n = 6, leading in one case to a termination of pregnancy on medical grounds). There were 42 live births (98%), at a median term of 38 weeks (range 27 to 42), of which 9 before 37 weeks (21%). Median birth weight was 2,940 grams (range 610 to 4,310). Five children (12%) were transferred to neonatal intensive care, and a boy born at 27 weeks died at two days of life. The risk of developing arterial hypertension during pregnancy was associated with previous chronic arterial hypertension and with subdiaphragmatic vascular involvement (p = 0.01 and p = 0.04). No correlation was found between disease activity and the obstetric complications described. The authors conclude that there is a high rate of obstetric complications with no significant impact on the live birth rate, and that pregnancy has no apparent influence on disease activity. Arsène Mekinian is second author and corresponding author of this work 8.

These data underline the value of a cardiovascular and obstetric assessment before conception and of joint follow-up during pregnancy: it is the pre-existing vascular condition, and not the measured inflammatory activity, that emerges from this series. The disease itself is dealt with on the page devoted to Takayasu arteritis.

No work of which he is a signatory has been found on pregnancy in ANCA-associated vasculitis, Behçet's disease or giant cell arteritis.

Antiphospholipid syndrome

Antiphospholipid syndrome is a particular situation in which the obstetric risk is directly built into the definition of the disease.

Arsène Mekinian's work has concerned in particular obstetric APS, its refractory forms, atypical laboratory profiles and the outcome of children exposed to maternal antibodies. It is on this last line of work that he is first author.

European prospective follow-up of children born to mothers with APS has helped to characterise their paediatric outcome and the dynamics of the maternal antibodies transmitted to the newborn.

The European registry of babies born to mothers with antiphospholipid syndrome, published in 2013 in the Annals of the Rheumatic Diseases, is a prospective European multicentre cohort with clinical examination, growth data, neurological developmental milestones and testing for antiphospholipid antibodies, at the ages of 3, 9 and 24 months and then 5 years. One hundred and thirty-four children were analysed (65 girls, birth weight 3,000 ± 500 grams, length 48 ± 3 centimetres). Sixteen per cent were born before 37 weeks (n = 22) and 14% weighed less than 2,500 grams at birth (n = 19). Neonatal complications were recorded in 18 cases (13%), including five infections (4%). During the five years of follow-up, no thrombosis and no systemic lupus were observed. Four children had behavioural abnormalities: autism, hyperactive behaviour, eating disorder with language delay, axial hypotonia with psychomotor delay. At birth, a lupus anticoagulant was present in 4 children (4%), IgG anticardiolipin antibodies in 18 (16%), IgG anti-beta-2-glycoprotein I antibodies in 16 (15%) and IgM in 3 (3%). These antibodies had disappeared by six months in 9 children (17%) and 9 children (18%) respectively, while positivity persisted in 10% of the children. Before the age of six months, the child's IgG anticardiolipin and anti-beta-2-glycoprotein I antibodies were correlated with the same antibodies in the mother (p < 0.05). The authors conclude that, despite the presence of these antibodies in the child, neither thrombosis nor lupus was observed, and that it is the abnormalities of neurological development that appear in the foreground and would warrant prolonged follow-up. He is first author and corresponding author of this work, of 30 named authors 1, and first signatory of a 2014 letter in Clinical and Experimental Rheumatology arising from the same registry, whose record carries no abstract and whose content could therefore not be read 4.

A single-centre retrospective study published in 2013 in Seminars in Arthritis and Rheumatism extends this work over the years 2003 to 2010. It compares 36 children born to 26 mothers with primary antiphospholipid syndrome with 12 children born to 9 mothers with systemic lupus. Autism spectrum disorders were observed in 3 children of the first group, all carrying persistent IgG anti-beta-2-glycoprotein I antibodies. In the second group, three children had cutaneous neonatal lupus and no developmental disorder was recorded. No significant difference was found between the two groups for the parameters at birth or during follow-up, apart from antinuclear antibodies being more frequent in the children of the lupus group (p < 0.05). The authors write themselves that the link between these cases of autism and exposure to the mother's antibodies must be confirmed. Arsène Mekinian is second author 2. The numbers are those of a series, not those of a risk study: that is the limit the authors set.

Obstetric APS and its treatment strategies are the subject of a specific page.

Autoinflammatory diseases

Autoinflammatory diseases constitute another line of research. What is at stake is to clarify the respective influence of inflammatory activity, treatments and pregnancy on maternal and obstetric risk.

Prospective multicentre work is being developed in this field, in particular in familial Mediterranean fever. The data currently available nevertheless remain partly derived from scientific communications and require full publication to allow a definitive analysis. In concrete terms, a congress abstract presented at the EULAR congress in 2025, numbered OP0288 and published in the supplement of the Annals of the Rheumatic Diseases, concerns pregnancy outcomes in autoinflammatory diseases: a prospective study of 117 cases, of which 79 with familial Mediterranean fever. It is a congress abstract and not an article: it is not indexed in PubMed, has no PMID, and has not been peer-reviewed as an original article. Only the title and the list of signatories could be read, the numbers cited appearing in the title itself; the content of the abstract has not been read and no result from it is taken up here. Arsène Mekinian is 10th signatory of twenty-two 11. Familial Mediterranean fever is dealt with on the page devoted to autoinflammatory diseases and amyloidosis.

In the same field, he is second author and corresponding author of a case report published in 2018 in Seminars in Arthritis and Rheumatism: an adult-onset Still's disease revealed during pregnancy in a woman of 38 already followed for diffuse systemic sclerosis and Sjögren's syndrome, with a ferritin of 41,000 nanograms per millilitre and a glycosylated ferritin below 5%, together with a review of 19 cases from the literature 6. A case report remains a case report: it describes a situation, it does not measure a risk.

Systemic sclerosis

Pregnancy in systemic sclerosis requires particular attention to vascular, cardiac, pulmonary and renal involvement.

The French multicentre work in which Arsène Mekinian took part has explored in particular the relations between obstetric history and later vascular phenotypes of the disease. The only article linking systemic sclerosis and pregnancy that he has signed is a multicentre observational case-control study published in January 2024 in RMD Open. It included, in 14 French hospital centres from July 2020 to July 2022, adult women meeting the 2013 EULAR criteria for systemic sclerosis and having had a pregnancy at least six months before diagnosis, that is 378 women: 129 cases with a vascular phenotype, defined by a history of ischaemic digital ulcers, pulmonary arterial hypertension, specific cardiac involvement or renal crisis, and 249 matched controls. A history of pre-eclampsia was reported in 5 cases (3.9%) and 12 controls (4.8%), with no association with the vascular phenotype (odds ratio 0.96, 95% confidence interval 0.28 to 3.34, p = 0.9). By contrast, the Rodnan skin score and a disease duration of five years or more were risk factors for the vascular phenotype. The main result is therefore negative, and that is how it must be read: a history of pre-eclampsia does not appear as a risk factor for the vascular phenotype. Arsène Mekinian is 15th author of twenty-four 10; the article is open access under a CC BY-NC licence.

This work forms part of a broader effort to characterise better the interactions between systemic vascular disease, placentation and obstetric complications. The disease is dealt with on the page devoted to systemic sclerosis.

Treatments and pregnancy

The management of treatments is a major element in preparing for pregnancy. The question is not only whether a drug can be continued during pregnancy, but also to avoid the unwarranted stopping of a treatment needed to control the disease.

Decisions rest on an individualised assessment of the maternal and fetal benefit-risk balance, taking account of the disease, its activity, the term of the pregnancy and the data available for each treatment.

The international recommendations on the compatibility of treatments during conception, pregnancy and breastfeeding constitute the reference framework of this assessment. Two EULAR texts are cited here, and Arsène Mekinian is a signatory of neither: the recommendations on women's health, family planning, assisted reproduction, pregnancy and menopause in systemic lupus and antiphospholipid syndrome, published in the Annals of the Rheumatic Diseases 2017;76(3):476-485, PMID 27457513, and published online on 25 July 2016 13; and the recommendations on the use of antirheumatic drugs in reproduction, pregnancy and lactation, 2024 update published in 2025 in the same journal 14. The date of 2017 is that of publication: the mention "EULAR 2016" that is commonly encountered refers to the advance online publication and to the manuscript number, and it is liable to be confused with the separate text devoted to antirheumatic drugs.

On treatments, he is last author of a French-language review published in 2025 in La Revue de médecine interne, devoted to hydroxychloroquine in recurrent immune-mediated obstetric disease, outside systemic lupus. This review reports that in 20 to 30% of primary obstetric antiphospholipid syndromes, the combination of an antiplatelet agent and prophylactic anticoagulation is not sufficient to prevent complications, a situation called refractory obstetric antiphospholipid syndrome; that no randomised controlled trial has assessed the addition of hydroxychloroquine to conventional treatment in this situation; that current data do not support its use in unexplained recurrent pregnancy loss; and that a few studies of low level of evidence suggest a benefit in chronic intervillositis of unknown aetiology, without this being established 12. This is a state of knowledge, not a course of action. Obstetric antiphospholipid syndrome, recurrent pregnancy loss and placental disease are dealt with on their respective pages.

Multidisciplinary care

These pregnancies often require coordination between internal medicine, obstetrics, fetal medicine, cardiology, nephrology, laboratory immunology and, depending on the disease, other specialties.

The work is developed within the department of internal medicine and clinical immunology of Saint-Antoine Hospital, AP-HP, Sorbonne Université, which takes part in the medical and university department devoted to inflammation, immunopathology and biotherapies, designated DHU i2B until about 2019, then DMU 3iD and DMU i3 in the affiliations of his publications. The affiliation he carries on his 2025 publication also mentions, on the same site, the reference centre for autoinflammatory diseases and inflammatory amyloidosis.

Following a pregnancy in this context brings together internal medicine and obstetrics. The work cited above is co-signed with obstetrics and neonatology teams identified in the affiliations of the articles themselves: department of obstetrics and pathology of Trousseau Hospital, department of obstetrics and medically assisted reproduction of Tenon Hospital, department of obstetrics and gynaecology of Jean-Verdier Hospital for the oldest work, as well as the medical intensive care and hepatology departments of Saint-Antoine for the case of Still's disease. It is this organisation by associated professions, and not a single place, that his publications describe.

What this multidisciplinarity covers has been measured. He is 9th author of twenty-one of an international survey published in 2023 in the Journal of Rheumatology, which mapped the organisation of care for pregnancies occurring in rare and complex connective tissue diseases. The responses come from 69 centres in 21 countries. Patients with systemic lupus or antiphospholipid syndrome were followed in more than 90% of centres, whereas other diseases, such as IgG4-related diseases, rarely were. A multidisciplinary team was involved in the majority of centres, with an obstetrician or gynaecologist in 91.3% of cases and other professionals less often. A formalised care pathway was described in 49.2% of centres, and 20.3% had a predefined monitoring protocol. Access to treatments during pregnancy was likewise heterogeneous. The authors conclude that there is a high level of care in these referral centres, with no significant difference between European and non-European countries, and that there is value in harmonising approaches 9.

Arsène Mekinian also takes part in the Groupe de Recherche Grossesse et Maladies Rares (GR2), a French research group whose name is kept here in French. The registry entry for this group on ClinicalTrials.gov, NCT02450396, sponsor AP-HP, describes it as an interdisciplinary research group on pregnancy and rare diseases. He has been a member since 2014. This fact appears in his 2025 curriculum vitae under a different wording, "Member of the French Group 'Pregnancy and Internal Medicine' (GR2) since 2014": the two wordings differ and this page reports both without settling between them. It is cross-checked by the MEDLINE record of the GR2 study published in 2022 in Rheumatology, where he is named among the collaborators of the GR2 Group consortium 15. In that same publication, he is not a named author: his contribution there is that of a collaborator of the group, a distinction that matters and that this page does not conceal. That 2022 publication reports 238 women included and declares the registration NCT02450396, whereas the public entry for that number, consulted on 14 September 2026, carries the status withdrawn and an actual enrolment of zero participants: the two sources cannot both be exact, and this page does not settle between them.

At French level, rare autoimmune and autoinflammatory diseases come under the networks of reference and competence centres coordinated by the rare disease health networks, and several of them are the subject of national diagnostic and care protocols published under the aegis of the Haute Autorité de santé. This page does not describe a consultation dedicated to preparing for a pregnancy at the Saint-Antoine site: nothing of the kind could be verified against a source, and this page therefore does not assert its existence.

What remains to be demonstrated

Knowledge varies greatly from one disease to another. For some diseases, the maternal and obstetric risk factors and the principles of care are relatively well established. For other rare diseases, the data still rest mainly on observational cohorts and registries.

Systemic lupus and pregnancy are not part of his work, and this page attributes none to him. Two PubMed searches redone on 8 September 2026, `Mekinian A[Author] AND pregnancy` (62 results, all reviewed) and `Mekinian A[Author] AND lupus` (47 results, all reviewed), bring up no original study of which he is a signatory concerning lupus and pregnancy. Only two signatures touch on this subject, and neither is a study of his own: a one-page letter published in 2016 in the Annals of Internal Medicine, a comment on an article published in the same journal in 2015, without an abstract, of which he is 5th of 5 named authors and whose content could not be read 5; and the comparison group of twelve children born to nine mothers with lupus in the 2013 study on the outcome of children 2. The framework for pregnancy in lupus therefore rests, on this page, on international references that are not his: the EULAR recommendations on women's health and family planning, Annals of the Rheumatic Diseases 2017;76(3):476-485, PMID 27457513, published online on 25 July 2016 13, and the EULAR recommendations on antirheumatic drugs, 2024 update published in 2025 14. Arsène Mekinian is among the authors of neither.

The limits of his own work. The 2020 Takayasu study is retrospective, concerns 43 pregnancies and is combined with a review of the literature: it describes frequencies, it does not measure a risk compared with a control population. The 2013 European registry of children is prospective but without a control group, and the four developmental abnormalities it reports are too few to establish a causal link; the authors of the 2013 study on autism write themselves that their observation must be confirmed. The 2024 systemic sclerosis study concludes that there is no association, a negative result obtained on a history of pre-eclampsia declared by questionnaire and rare in both groups, which limits the power of the comparison; this result has not been replicated to our knowledge. The work on anti-SSA antibodies is a letter whose content is not accessible at source. The work on autoinflammatory diseases is a congress abstract, a format that is not equivalent to a peer-reviewed article, and it may never become an article. The case of Still's disease is a single case. The survey on care pathways describes what 69 referral centres declare, which is neither a picture of ordinary practice nor a measurement of outcomes for patients.

What is missing. No work of which he is a signatory has been found on pregnancy in ANCA-associated vasculitis, Behçet's disease or giant cell arteritis, nor on postpartum flares considered in their own right. On the compatibility of treatments, the 2025 review that he co-signs notes that there is no randomised controlled trial on the addition of hydroxychloroquine in refractory obstetric antiphospholipid syndrome, and that the data do not support its use in unexplained recurrent pregnancy loss: the question is open, it is not settled, and it is not resolved on a web page but with the doctor following the pregnancy, in the light of the applicable French and European sources.

The main research questions concern the individualised prediction of risk, the influence of disease activity on pregnancy, the role of autoantibodies and of vascular involvement, as well as the safety and efficacy of treatments during pregnancy. The aim is to develop care pathways that reconcile optimal control of the maternal disease, treatment safety and the best possible obstetric and fetal prognosis.

References

Published work he has taken part in, on this subject.

General information only. This page does not replace individual medical advice. Updated: 10 September 2026.