Pregnant with Sjögren’s Syndrome? What You Need to Know

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Sjögren’s syndrome is what doctors call an autoimmune disease. This means a disease resulting from your immune system attacking certain body tissues, as if they were foreign to your body. It is a chronic disease, meaning long-term abnormality. In Sjögren’s syndrome, the immune system attacks fluid-producing glands, especially salivary glands and tear glands. This leads to dry mouth (xerostomia) and dry eyes (xerophthalmia). Sjögren’s syndrome is reported to be present in 0.1 to 4.8 percent of people, but it strikes woman 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’s syndrome. If you are considering pregnancy, or if you become pregnant, it is important to know if you have Sjögren’s syndrome, because there is concern that the antibodies produced by the immune system in the disease process may cause problems for your baby.

Initial clues that you may suffer from Sjögren’s 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. Your eyes may feel burning, gritty, or itchy. Additional symptoms that may occur include cough, swollen salivary glans, dry skin, vaginal dryness, skin rash, and joint swelling or pain. Your mouth may feel so dry that it is difficult to swallow or speak, while your eyes may feel burning, gritty, or itchy. Various other problems also have associations with Sjögren’s syndrome (occur with increased frequency in those with the condition), including irritable bowel syndrome, lung infections, and Raynaud phenomenon, characterized by numbness and pain in the hands when exposed to the cold. Sjögren’s syndrome also is associated with an elevated risk for developing a type of cancer called non-Hodgkin lymphoma.

An ophthalmologist will examine your eyes, checking for drying and signs of damage from drying. The ophthalmologist will also perform what’s called the Schirmer tear test. This is a rather low-tech test that measures the amount that the eyes are able to tear by way of tissue paper held near the eye to see how much liquid absorbs into the paper. 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 makers of inflammation (erythrocyte sedimentation rate [ESR], C reactive protein), and tests for anti-SS-A (anti-Ro) and anti-SS-B (anti-La) antibodies. There also are a range of tests to determine whether your symptoms are due to primary Sjögren’s syndrome as opposed to being part of another rheumatological condition that includes Sjögren’s 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.

Sjögren’s syndrome causes your immune system to produce antibodies, some of which may possibly move through the placenta and reach the baby, causing a skin rash and congenital heart problems.

Sjögren’s syndrome is often treated with medications that inhibit inflammation and that can be applied as eyedrops, such as cyclosporine. 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 to those with Sjögren’s syndrome, but there are questions about its safety in 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. Cyclosporine eye drops are not thought to present an issue for breastfeeding, but there is concern about pilocarpine entering breast milk, even if you take it in the form of eye drops. Uncertainty and controversy surrounds the question of methotrexate in the setting of breastfeeding.

Apart from medications, dry eyes of Sjögren’s 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. Women with Sjögren’s syndrome should avoid smoking, but there are numerous other reasons not to smoke, whether you are pregnant or not.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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