akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2026.774akusherstvo-2820Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРPregnancy and autoimmune diseases: from immunological tolerance to placenta-associated complicationsБеременность при аутоиммунных заболеваниях: от иммунологической толерантности к плацента-ассоциированным осложнениямhttps://orcid.org/0000-0002-0725-9686ХизроеваД. Х.KhizroevaJ. Kh.

Хизроева Джамиля Хизриевна, д.м.н., проф.

Scopus Author ID: 57194547147.

WoS ResearcherID: F-8384-2017.

Россия, 119048 Москва, ул. Трубецкая, д. 8, стр. 2;Улица Крозатье, 34, F-75012 Париж, Франция

Jamilya Kh. Khizroeva, MD, Dr Sci Med, Prof.

Scopus Author ID: 57194547147.

WoS ResearcherID: F-8384-2017.

8 bldg. 2, Trubetskaya Str., Moscow 119048, Russia; 34 rue Crozatier 75012 Paris, France

jamatotu@gmail.comhttps://orcid.org/0000-0002-3628-0804ТретьяковаМ. В.TretyakovaM. V.

Третьякова Мария Владимировна, к.м.н. 

Scopus Author ID: 57216415260.

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Maria V. Tretyakova, MD, PhD.

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8 bldg. 2, Trubetskaya Str., Moscow 119048

https://orcid.org/0009-0005-3124-0423ГукасянЭ. А.GukasyanE. A.

Гукасян Эрика Артаковна 

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Erika A. Gukasyan

8 bldg. 2, Trubetskaya Str., Moscow 119048

https://orcid.org/0009-0006-1782-1966ОсколковаА. Р.OskolkovaA. R.

Осколкова Арина Романовна 

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Arina R. Oskolkova

8 bldg. 2, Trubetskaya Str., Moscow 119048

https://orcid.org/0009-0003-0348-2252ШаталоваО. В.ShatalovaO. V.

Шаталова Олеся Владимировна 

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Olesya V. Shatalova

8 bldg. 2, Trubetskaya Str., Moscow 119048

https://orcid.org/0009-0002-8328-9024СафарянЭ. А.SafaryanE. A.

Сафарян Элина Александровна 

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Elina A. Safaryan

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https://orcid.org/0000-0001-8404-1042БицадзеВ. О.BitsadzeV. O.

Бицадзе Виктория Омаровна, д.м.н., проф., профессор РАН 

Scopus Author ID: 6506003478.

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Victoria O. Bitsadze, MD, Dr Sci Med, Prof., Professor RAS. 

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Галуаева Карина Махарбековна 

362003 Республика Северная Осетия – Алания, Владикавказ, ул. Барбашова, д. 39

Karina M. Galuaeva, MD.

39 Barbashova Str., Vladikavkaz, Republic of North Ossetia-Alania 362003

https://orcid.org/0000-0002-2541-3843МакацарияН. А.MakatsariyaN. A.

Макацария Наталия Александровна, к.м.н.

WoS ResearcherID: F-8406-2017.

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Nataliya A. Makatsariya, MD, PhD.

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https://orcid.org/0009-0001-3790-3401ЧитаеваК. Х.ChitaevaK. Kh.

Читаева Катерина Хасановна 

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Katerina Kh. Chitaeva, MD. 

8 bldg. 2, Trubetskaya Str., Moscow 119048

https://orcid.org/0000-0002-9899-9910ГриЖ. К.GrisJ.-C.

Гри Жан-Кристоф, д.м.н., проф., иностранный член РАН

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Jean-Christophe Gris, MD, Dr Sci Med, Prof., Foreign Member of RAS.

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https://orcid.org/0000-0002-9576-1368ЭлаламиИ.ElalamyI.

Элалами Исмаил, д.м.н., проф., иностранный член РАН 

Scopus Author ID: 7003652413.

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Ismail Elalamy, MD, Dr Sci Med, Prof., Foreign Member of RAS.

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Геротзиафас Григориос, д.м.н., проф., иностранный член РАН 

Россия, 119048 Москва, ул. Трубецкая, д. 8, стр. 2;Улица Крозатье, 34, F-75012 Париж, Франция;Франция, 75020 Париж, Китайская улица, д. 4;Франция, 75013 Париж, бульвар Госпитале, 91

Grigoriоs Gerotziafas, MD, Dr Sci Med, Prof., Foreign Member of RAS. 

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Ван Дреден Патрик, д.м.н., проф. 

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Patrick Van Dreden, MD, Dr Sci Med, Prof.

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12 Rue de la Faculté de Médecine, Paris 75006, France

ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Медицинский Университет Сорбонны, INSERM UMR_S_938, Сент-Антуанский исследовательский центр (CRSA), Группа "Биология и терапия рака", Группа "Рак - ангиогенез - тромбоз", Университетский институт онкологии (UIC)РоссияSechenov University; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), UMR S_938, Research Team "Cancer, Vessels Biology and Therapeutics" (CaVITE), Research Group “Cancer, Angiogenesis, Thrombosis and Hemostasis”, Thrombosis Center, Kourilsky BuildingRussian FederationФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияSechenov UniversityRussian FederationГБУЗ «Поликлиника № 4» МЗ РСО-АланияРоссияPolyclinic No. 4, Ministry of Health of the Republic of North Ossetia-AlaniaRussian FederationФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Университет МонпельеФранцияSechenov University; University of MontpellierFranceФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Частный университет Марракеша; Американский госпиталь ПарижаФранцияSechenov University; Hematology Department, Faculté Privee de Médecine de Marrakech (FPMM); Hopital Americain de ParisFranceФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Медицинский Университет Сорбонны, INSERM UMR_S_938, Сент-Антуанский исследовательский центр (CRSA), Группа "Биология и терапия рака", Группа "Рак - ангиогенез - тромбоз", Университетский институт онкологии (UIC); Госпиталь Тенон; Медицинский факультет Университета Сорбонна; Отдел клинических исследований, Diagnostica Stago GennevilliersРоссияSechenov University; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), UMR S_938, Research Team "Cancer, Vessels Biology and Therapeutics" (CaVITE), Research Group “Cancer, Angiogenesis, Thrombosis and Hemostasis”, Thrombosis Center, Kourilsky Building; Hospital Tenon; Sorbonne University Faculty of MedicineRussian FederationМедицинский факультет Университета Сорбонна; Отдел клинических исследований, Diagnostica Stago GennevilliersФранцияSorbonne University Faculty of Medicine; Clinical Research Department, Diagnostica Stago GennevilliersFrance20262005202600Online First2820Copyright © Khizroeva J.K., Tretyakova M.V., Gukasyan E.A., Oskolkova A.R., Shatalova O.V., Safaryan E.A., Bitsadze V.O., Galuaeva K.M., Makatsariya N.A., Chitaeva K.K., Gris J.К., Elalamy I., Gerotziafas G., Van Dreden Р.В., 20262026Хизроева Д.Х., Третьякова М.В., Гукасян Э.А., Осколкова А.Р., Шаталова О.В., Сафарян Э.А., Бицадзе В.О., Галуаева К.М., Макацария Н.А., Читаева К.Х., Гри Ж.К., Элалами И., Геротзиафас Г., Дреден П.В.Khizroeva J.K., Tretyakova M.V., Gukasyan E.A., Oskolkova A.R., Shatalova O.V., Safaryan E.A., Bitsadze V.O., Galuaeva K.M., Makatsariya N.A., Chitaeva K.K., Gris J., Elalamy I., Gerotziafas G., Van Dreden Р.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2820

Autoimmune diseases and pregnancy represent a complex interplay among the immune, vascular, and endocrine systems. Physiological pregnancy is accompanied by dynamic immune adaptation, including the establishment of immunological tolerance, modulation of the Th1/Th2/Th17/Treg balance, and activation of innate immune mechanisms. In autoimmune diseases, these processes may become dysregulated, contributing to endothelial dysfunction, thromboinflammation, complement activation, and placental insufficiency. This review summarizes current concepts on the mechanisms of immune adaptation during pregnancy and the roles of innate and adaptive immunity, microchimerism, the complement system, and neutrophil extracellular traps in the pathogenesis of autoimmune and placenta-associated complications. It also examines the impact of autoantibodies on pregnancy outcomes, including antiphospholipid antibodies as well as anti-Ro/SSA (Ro/Sjögren syndrome-related antigen A), anti-La/SSB (La/Sjögren syndrome-related antigen B), anti-thyroid peroxidase, ANCA (antineutrophil cytoplasmic antibodies), and anti-tissue transglutaminase antibodies. The review discusses the mechanisms underlying preeclampsia, fetal growth restriction, pregnancy loss, and preterm birth, including impaired placentation, endothelial dysfunction, and immunoinflammatory activation. The influence of pregnancy on the course of autoimmune diseases is also considered, including the immunological changes observed in rheumatoid arthritis, multiple sclerosis, and systemic lupus erythematosus, as well as the role of postpartum reactivation of autoimmune inflammation. Current principles of multidisciplinary pregnancy management for women with autoimmune diseases are presented, including preconception counseling, control of disease activity, safe therapy, and postpartum follow-up. Unresolved issues in reproductive immunology, prospects for identifying biomarkers of pregnancy complications, and the development of personalized approaches to managing patients with autoimmune pathology are also discussed.

Аутоиммунные заболевания и беременность представляют собой сложную модель взаимодействия иммунной, сосудистой и эндокринной систем. Физиологическая беременность сопровождается динамической иммунной адаптацией, включающей формирование иммунологической толерантности, изменение баланса субпопуляций T-лимфоцитов – Т-хелперов 1-го, 2-го и 17-го типов (англ. T-helper 1, 2, 17; Th1/Th2/Th17), а также регуляторных T-клеток (англ. T-regulatory cells, Treg) и активацию механизмов врожденного иммунитета. При аутоиммунных заболеваниях данные процессы могут нарушаться, что способствует развитию эндотелиальной дисфункции, тромбовоспаления, активации комплемента и плацентарной недостаточности. В обзоре рассмотрены современные представления о механизмах иммунной адаптации беременности, роли врожденного и адаптивного иммунитета, микрохимеризма, системы комплемента и нейтрофильных внеклеточных ловушек в патогенезе аутоиммунных и плацента-ассоциированных осложнений. Особое внимание уделено влиянию аутоантител на течение беременности, включая антифосфолипидные антитела, а также антитела к Ro/SSA (англ. Ro/Sjögren syndrome-related antigen A), La/SSB (англ. La/Sjögren syndrome-related antigen B), к тиреоидной пероксидазе (ТПО), антинейтрофильные цитоплазматические антитела (англ. antineutrophil cytoplasmic antibodies, ANCA) и антитела к тканевой трансглутаминазе (тТГ). Обсуждаются механизмы нарушения плацентации, эндотелиальной дисфункции и иммуновоспалительной активации, лежащие в основе преэклампсии, задержки роста плода, невынашивания беременности и преждевременных родов. Рассмотрено влияние беременности на течение аутоиммунных заболеваний, включая особенности иммунологической перестройки при ревматоидном артрите, рассеянном склерозе и системной красной волчанке, а также значение послеродовой реактивации аутоиммунного процесса. Представлены современные принципы междисциплинарного ведения беременности при аутоиммунных заболеваниях, включая преконцепционную подготовку, контроль активности заболевания, безопасную терапию и послеродовое наблюдение. Обсуждаются нерешенные вопросы репродуктивной иммунологии, перспективы поиска биомаркеров осложнений беременности и развития персонализированных подходов к ведению пациенток с аутоиммунной патологией.

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The authors declare that there are no conflicts of interest present.