Are Positive ANA levels linked with Preeclampsia?

[nicw]

A year before falling pregnant i tested ANA positive with a titer of 1:1280 speckled. Subsequent testing 3 months later showed a titer of 1:640 speckled. Negative ENA panel. I was referred to a Rheumatologist due to associated joint pain and fatigue. The Rheum suggested it was due to a virus... hmmm. Prior to falling pregnant i was tested once more with a weird result of 1:200 nuclear envelope pattern. My doctors didn't seem concerned and didn't warn me of any possible effects it could have on pregnancy so around six months later i fell pregnant. During the pregnancy my joint pain disappeared but i developed severe PE and possibly HELLP (i had mild thrombocytopenia, hemolysis and abnormal LFT's). DD was IUGR. Second pregnancy i took aspirin and developed PE again with DS SGA.

I recently developed hypertension and since then have developed the joint pain and fatigue again. Once again i am ANA positive. My Doctor is wanting me to hold off on a third pregnancy until i see another Rheum.

For those of you who have more research knowledge in the causes of Preeclampsia is it possible that the positive ANA is what caused my Preeclampsia? I have tested negative again in the ENA panel, APS etc.
Is a positive ANA more likely to cause problems in pregnancy?

[kara]

A positive ANA poits towards autoimmune problems such as lupus, rheumatoid artherities, and a whole host of other things. While a positive ANA isn't directly linked as a cause of preeclampsia, and underlying immune system problem can be a risk factor for preeclampsia. How far along were you when you developed pe/hellp?

Some of us just have heightened immune systems, but with nothing clearly diagnoseable, even with an ANA. I concur that it might be time for a second rheumie opinion. Have they chcked your ESR? Erythrocyte Sedimentation Rate will pick up signs of inflammation.

Do you see a regular OB or an MFM/Perinatologist for pregnancy?

[nicw]

Hi Kara, Thanks for your reply. I was 33.5 weeks when i developed PE/HELLP the first time. I delivered at 35 weeks. The second time i developed PE at 36 weeks and delivered at 37 weeks with less problems. My ESR has always been normal but recently my CRP has become elevated. My ob is a high risk ob who consults with a Nephrologist during my pregnancies. I have no underlying kidney problems and was puzzled at first that i was sent to a Nephrologist but my ob explained that i needed one to rule out kidney causes and that due to the insult on the kidneys from the PE i would need follow up just in case. He has suggested we consult with the Nephrologist now and the Rheum in order to pinpoint the problem before falling pregnant again. Its frustrating to say the least. I suspect i may remain undiagnosed with whatever is happening as it seems so elusive. I would be reluctant to proceed with another pregnancy without a diagnosis. The rheum i have been referred to is connected to a major women's obstetric hospital and has a special interest in obstetrics as well as Rheumatology which makes me feel slightly better. Thanks again.

[kara]

It sounds like you've got your bases covered with the specialists. It's encouraging that you had a near term and term delivery. Many times PE comes on later and milder in subsequent pregnancies - which might bode well for a third. It is a good idea to rule everything out, but I wouldn't give up hopes of another baby if you really want one. MANY of our members never have diagnosis, but manage to complete their families, especially with a history of near term deliveries. Obviously, there are no promises. Some have finally gotten a diagnosis of something after 3 pregnancies. Some might get a diagnosis later in life. I was going to suggest getting acquired clotting disorders rechecked, but with deliveries past 34 weeks, clotting disorders are less likely a culprit. It could be something like Chronic Fatigue or Fibromylagia for which there aren't definitive lab tests, but only clinical symptoms such as fatigue and pain.

Let us know what happens with your appointments.

[nicw]

Thanks again for your advice Kara. At this stage my general physician is thinking i have mixed connective tissue disease. Hopefully the Rheum will have more of an idea when i see her. My appt is in 5 weeks. I will let you know how i go. At least if i continue to consult with a Rheum whatever i have will be better managed. Therefore if i do decide on another pregnancy i will be monitored carefully by all the right specialists from the beginning.

[nicw]

Hi Kara,

Just an update on my Rheum appointment. I have been diagnosed with Undifferentiated Connective Tissue Disease and commenced on prednisolone in the short term and plaquenil long term. The complicated pregnancies and other symptoms (raised CRP, chest pain, non deforming arthralgia, cervical lymphadenopathy etc) were enough to alert her that something underlying was definitely going on.

I have put plans for a third child on hold for now and I'm looking forward to commencing treatment in order to improve my symptoms. It been a long tough journey.

Thanks for your help.