Undiagnosed lupus and unexplained stillbirth

Dr Ian Crocker, Dr Clare Tower, Dr Ian Bruce, Dr Ed Johnstone, Dr Hannah Kither

Together with the charity Sparks, Tommy’s researchers have found that a significant proportion of women with unexplained pregnancy loss have an undiagnosed autoimmune disease.

Lupus is a rare autoimmune disease that mainly affects women, in which the immune system attacks healthy cells. It is complicated and not well understood, but women who suffer from it have a 1 in 5 chance of losing their baby through miscarriage or stillbirth. Many women with lupus take a long time to be diagnosed, so they may suffer losing their baby without knowing they have the disease.

We have found that this is why some women have “unexplained” miscarriages or stillbirths: they have an undiagnosed illness harming their baby without them knowing. 

Together with Sparks charity, we set up the Lupus in Pregnancy Study (LIPS) clinic in Manchester. Researchers have been looking at women who have previously suffered the loss of a baby to see if they might have had a lupus-like illness affecting their immune systems. 

The main way that this was done was testing for antibodies – these normally attack harmful intruders in our bodies – that attack our own cells. These are known as auto-antibodies. We studied 39 women who had suffered from an earlier miscarriage or stillbirth, most of whom were pregnant again during the study.

We found that a significant proportion (over 20%) of the women we looked at, previously undiagnosed with any lupus-like illness, had auto-antibodies in their blood during a later pregnancy. As their auto-antibodies are specific to each pregnancy, this might explain why they suffered losing their babies in earlier pregnancies. 

We also used national databases to look at records of miscarriages and stillbirths, to see if these could have been related to lupus. In a database of pregnancies in the North-West, we found that there was a direct link between a diagnosis of lupus, and losing a baby. We also used a national clinical database to look at information from over 4.5 million pregnancies. Early results suggest that around 3-5% of stillbirths may be because of undiagnosed autoimmune disease during pregnancy. 

Currently being prepared for publication, we hope that this research will have clinical impact straight away. Women should be tested early on to see if they have immune problems: the earlier doctors know this, the more they can help women at risk, and make sure they are watched closely throughout pregnancy.

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Funding

This study takes place in a Tommy's centre and is funded by Tommy's and Sparks charity

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