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The coincidence of systemic autoimmune diseases and pregnancy may modify the outcome of the disease and the pregnancy due to the background immunologic and hormonal processes. The great majority of patients with autoimmune diseases are young females in their reproductive years, willing to have babies. Consequently, we have to prepare for this special situation. Our concept on childbearing in autoimmune women has changed within the last 30 years. Earlier, systemic lupus erythematosus flared in about 50% of patients during pregnancy, but the flare rate has significantly decreased recently. This improvement can be attributed to increased attention to low diseases activity at the time of conception, which might reduce to the half of the risk for flare. Tight control of patients and appropriate use of corticosteroids also contribute to the better results. The adequate use of anti-thrombotic agents resulted in a significant amelioration of pregnancy outcome in antiphospholipid syndrome. The earlier use of methotrexate and the introduction of tumor necrosis factor-alpha inhibitors in the treatment of rheumatoid arthritis have changed the natural characteristics of the disease. The increase in remission rate indirectly has beneficial effect on the number of planned and carried out pregnancies. Authors review the connection between systemic autoimmune disorders and pregnancy as well as the possibilities of medical treatment of such diseases during pregnancy.

Patients with antiphospholipid syndrome have a high frequency of mid-pregnancy intrauterine growth retardation or fetal death. The authors report the case of a 28 year old pregnant woman with antiphospholipid syndrome with severe obstetrical complications (spontaneous abortion, missed abortion) in the past history. By means of the administration of combined immunomudulant (intravenous immunoglobulin, steroid), anticoagulant and antiplatelet therapy we could prevent a subsequent pregnancy loss of the patient. Apropos of this case the authors give an overview on the monitoring of the disease and the therapeutical recommendations of the literature.

Introduction: Antiphospholipid syndrome is an autoimmune disorder, defined as the association of antiphospholipid antibodies with manifestations of venous or arterial thrombosis or pregnancy loss. Primary antiphospholipid syndrome means that the patients have the same clinical symptoms and laboratory findings but they are not suffering from systemic lupus erythematosus or a closely related autoimmune diseases. Secondary antiphospholipid syndrome occurs in association with autoimmune or other diseases., Aim, Methods, Results: 31 pregnancies of 10 women are detailed. 22 pregnancies were without thromboembolic prophylaxis and only 2 pregnancies were successful (9.1%). Out of the 9 pregnancies with high dose low-molecular-weight heparin and low dose aspirin thromboprophylaxis throughout pregnancy 8 were successful (88.8%). All the newborns were healthy. In spite of the long-term low-molecular-weight heparin therapy side effects (osteoporosis or heparin-induced thrombocytopenia) were not observed., Conclusion: Considering these results high-dose low-molecular-weight heparin and low dose aspirin prophylaxis is recommended for pregnant women with antiphospholipid syndrome throughout pregnancy.

Antiphospholipid antibodies predispose to venous and arterial thrombosis. The case of a sixteen-year-old boy with primary antiphospholipid syndrome is presented. Features of different organ involvement such as thrombosis of the inferior vena cava, pulmonary thromboembolism and cerebral involvement were present with thrombocytopenia and high titre of anticardiolipin in the patient's sera. On twelve-month follow-up while taking anticoagulant the patient was entirely free of symptomes though certain immunological findings showed slight positivity. However, considering the ARA criteria systhemic immunopathologic disorder could not have been proved. Other pathological conditions with anticardiolipin positivity were also excluded.

A case of a successful pregnancy is presented in a woman with anti-phospholipid syndrome and habitual abortions. She was treated with heparin-salicyl therapy during her pregnancy. No complications were noted. The significance of the presence of anti-phospholipid antibodies is stressed. The other therapeutic possibilities are discussed.