%0 Journal Article
%T Uveitis and Gender: The Course of Uveitis in Pregnancy
%A Nathalie P. Y. Chiam
%A Lyndell L. P. Lim
%J Journal of Ophthalmology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/401915
%X The hormonal and immunological changes in pregnancy have a key role in maintaining maternal tolerance of the semiallogeneic foetus. These pregnancy-associated changes may also influence the course of maternal autoimmune diseases. Noninfectious uveitis tends to improve during pregnancy. Specifically, uveitis activity tends to ameliorate from the second trimester onwards, with the third trimester being associated with the lowest disease activity. The mechanism behind this phenomenon is likely to be multifactorial and complex. Possible mechanisms include Th1/Th2 immunomodulation, regulatory T-cell phenotype plasticity, and immunosuppressive cytokines. This clearly has management implications for patients with chronic sight threatening disease requiring systemic treatment, as most medications are not recommended during pregnancy due to lack of safety data or proven teratogenicity. Given that uveitis activity is expected to decrease in pregnancy, systemic immunosuppressants could be tapered during pregnancy in these patients, with flare-ups being managed with local corticosteroids till delivery. In the postpartum period, as uveitis activity is expected to rebound, patients should be reviewed closely and systemic medications recommenced, depending on uveitis activity and the patient¡¯s breastfeeding status. This review highlights the current understanding of the course of uveitis in pregnancy and its management to help guide clinicians in managing their uveitis patients during this special time in life. 1. Introduction Pregnancy is associated with various hormonal and immunological changes that facilitate the survival of the semiallogeneic foetus. These physiological changes influence the course of various maternal autoimmune diseases [1, 2]. The effect of pregnancy on noninfectious uveitis has not been as extensively studied; however, to date it has been well described by a few authors. It is essential to understand the course of uveitis in pregnancy as uveitis has a peak incidence in young adults and it is not uncommon for female patients with known uveitis to become pregnant. This review will examine the literature on the course of uveitis in pregnancy and its management. This summary would hopefully help guide clinicians in the management of uveitis during pregnancy and the postpartum period. 2. Theories on How Pregnancy Influences Uveitis During pregnancy, the tolerance of the semiallogeneic foetus is made possible by the various hormonal and immunological changes in pregnancy. These physiological changes also have a role in influencing the course of
%U http://www.hindawi.com/journals/joph/2014/401915/