Category: Academic Reportage

Source: The Conversation – USA – By Matthew J. Mayhew, Professor of Higher Education, The Ohio State University

Universities, often perceived as bastions of progressive thought, are increasingly reflecting the broader political polarization gripping the nation.

Faculty members represent a university’s core identity and mission. They express the values of the institution in numerous ways, including teaching, mentoring, advising and researching.

In my research into the impact of college on student development and learning, I – and others – have found that faculty are the most important people influencing student learning, development, persistence and degree attainment.

However, no systematic efforts have ever been undertaken to find out how faculty’s work is influenced by their understanding of university life and religion – until now.

The Templeton Religion Trust, a charity focused on improving societal well-being through understanding individual well-being, funded a recent national survey my team and I administered to 1,000 faculty members. The survey asked faculty about their perceptions of university life, including free speech and diversity, equity and inclusion initiatives, often shortened to simply DEI.

The survey results reveal a striking divergence in perspectives on the often divisive issues of free speech and DEI among faculty. Those differences showed up particularly along the red state and blue state divide.

Yet, amid these deep disagreements, a surprising point of bipartisan consensus emerges: faculty members’ belief in the importance of religious, spiritual and secular inclusion in diversity efforts.

State political leaning is key

Survey responses represented national trends across various factors, including region, institutional control, institutional type and academic discipline.

In part of the analysis, we uncovered that the political leanings of a state – how a state voted in the presidential election of 2024 – play a significant role in what faculty perceive about free speech and DEI programming.

Even more compelling, significant differences reported by faculty from red versus blue states showed up consistently across gender, race, religion, academic discipline, faculty rank and whether the faculty member was employed at a private or public institution.

In other words, political leanings of a state were strongly associated with faculty perceptions regardless of these other factors.

Measuring the right to free speech

We asked faculty four questions related to their First Amendment rights, which we presented as: “The First Amendment protects freedom of speech, freedom of religion, freedom of the press, freedom of assembly, and freedom to petition.”

Working closely with experts in legal epidemiology, we asked faculty the extent to which they agreed with the following statements: a) the First Amendment is relevant to my job as a faculty member; b) the First Amendment is relevant to my research engagement; c) my institution provides me with my constitutionally mandated First Amendment rights; and d) I am aware of my rights and responsibilities as they relate to the First Amendment of the U.S. Constitution.

While awareness of First Amendment rights appears consistent across the board, a notable difference arises in faculty members’ perception of institutional protection of those rights.

Faculty in blue states are significantly more likely than those in red states to report that their institutions uphold their constitutionally mandated First Amendment rights. This implies a potential disconnect in how freedoms are experienced and protected, depending on the political leanings of the state where an institution is located.

Measuring attitudes about DEI

The divide deepens when it comes to DEI, defined in the survey as “campus diversity programs” in some instances and “diversity, equity, and inclusion” in others.

When compared with faculty in blue states, those in red states are far more inclined to view DEI efforts as “overreach,” agreeing with the statements that “diversity programs generally do more harm than good on college and university campuses” and “the promotion of diversity, equity, and inclusion on college and university campuses has gone too far.”

Conversely, blue state faculty largely disagree with these assertions. When compared with faculty in red states, those in blue states were more likely to agree that “campus diversity programs support student success,” demonstrating a stark ideological chasm on the value and impact of DEI.

This partisan disagreement extends to the very concept of banning DEI programs.

Red state faculty show moderate support for banning DEI, suggesting a belief that current efforts to curtail campus diversity initiatives are, according to survey response options, “well justified.”

Blue state faculty overwhelmingly support the continuation of these programs. They gave strong endorsement to the idea that “colleges and universities should continue to offer identity-specific organizations and programming.”

This schism reflects the ongoing national debate about the role and scope of DEI in higher education. Faculty perspectives mirror the political sentiments of their respective regions.

Amid this significant polarization, a crucial area of common ground emerges: what we call religious, spiritual and secular inclusion.

That’s the idea that DEI efforts should include programming and activities designed to help students from all religious, spiritual and secular backgrounds belong and succeed.

Religious, secular and spiritual diversity

Despite their sharp disagreements on other aspects of DEI, both red state and blue state faculty overwhelmingly agree that “colleges and universities should provide support for students of all religious, secular, and spiritual identities and backgrounds.”

And both groups similarly reject the notion that “campuses should not concern themselves with religious, secular and spiritual diversity.”

The findings from this survey highlight the complex landscape of faculty opinion in higher education. While significant difficulties remain in reconciling differing views on free speech and DEI, the shared commitment to religious, spiritual and secular inclusion offers a potential path to agreement.

By focusing on areas of consensus, institutions can begin to foster more inclusive environments to serve the needs of all students, regardless of their background or beliefs. Understanding these nuanced perspectives is the first step toward building more cohesive, pluralistic and intellectually vibrant academic communities across the nation’s varied political terrain.

Matthew J. Mayhew receives funding from the Templeton Religions Trust, the Arthur Vining Davis Foundations, the Pew Charitable Trusts, the Educational Credit Management Corporation (ECMC) Foundation, the National Science Foundation, the Alfred P. Sloan Foundation, the Merrifield Family Trust, the Andrew W. Mellon Foundation, the Fetzer Institute, the Ewing Marion Kauffman Foundation, the Merrifield Family Trust, and the United States Department of Education.

– ref. Supporting religious diversity on campus is a surprising consensus among faculty across the red-blue divide – https://theconversation.com/supporting-religious-diversity-on-campus-is-a-surprising-consensus-among-faculty-across-the-red-blue-divide-262589

Source: The Conversation – USA – By Justin Dunnavant, Assistant Professor of Anthropology, University of California, Los Angeles

“For a long time now, a large number of [escaped slaves] have established themselves on lofty Maroon Hill in the mountains toward the west end of the island [of St. Croix]. … They are there protected by the impenetrable bush and by their own wariness.”

Those are the words of Christian Oldendorp, a Danish missionary who visited the Caribbean island of St. Croix in 1767. His account is one of the few Danish historical records of Maronberg, a community of escaped slaves, known as Maroons, in the northwest mountain ranges of the island.

In 1733, the Danish West India-Guinea Company purchased St. Croix from France and quickly expanded the island’s sugar and cotton production. This also meant expanding the slave population to harvest lucrative plantations. But the Danes were never able to fully control the island – or the enslaved. By the end of the 1700s, nearly 1,400 people – more than 10% of the enslaved population – successfully escaped captivity. But where did they escape to? Only recently have researchers started to shed more light on this centuries-old mystery.

As an archaeologist specializing in slavery and resistance, I’ve excavated plantations in the Americas and used geographic information systems to model Maroon escape routes by sea. Recently, I turned my attention to Maroon settlements on land, working with a team of archaeologists to locate Maronberg.

Honoring a legacy

I first learned about Maronberg on a nature tour of St. Croix given by local activist and University of the Virgin Islands professor Olasee Davis in 2016. At that time, I was on the island to excavate a sugar plantation, a project that gave my colleagues and me a unique perspective on the enslaved experience in the Danish-controlled Caribbean.

In August 2025, Davis’ decades-long campaign to create an official heritage sanctuary to protect Maronberg finally came to fruition. The local government purchased 2,386 acres of land to serve as the U.S. Virgin Islands Maroon Territorial Park.

But one problem remains: We have yet to find the physical remains of the settlement. Locating and preserving Maronberg’s historical artifacts and buildings could provide new insight into residents’ way of life and give greater meaning to the sanctuary.

Fortunately, advanced computer modeling and high-resolution maps are helping us get closer to pinpointing the settlement.

Finding what was meant to remain hidden

Many Maroon settlements in the Americas have proved difficult to locate. This makes sense when you consider that their inhabitants were trying to hide from colonial settlers. If the Danes had found Maronberg, they would have either killed its inhabitants or forced them back into slavery.

Runaways tended to settle in areas that were intentionally difficult to access, like remote swampy or mountainous terrain. Houses and other shelters often consisted of semipermanent structures so that Maroons could relocate as needed to avoid detection.

The boundaries of Maronberg and the size of the settlement along the northwestern mountain range remain unknown. Colonial militias attempted periodic raids, but historical records report that they were met with rugged terrain, booby traps and counterattacks.

The missionary Oldendorp wrote: “[The Maroons] keep every approach safe by attempting carefully to conceal small, pointed stakes of poisoned wood so that the unwary pursuer might wound his foot on them and therefore be prevented from continuing the chase as a result of the unbearable pain.”

All those precautions paid off: The Danes were never able to penetrate the Maroons’ encampment.

Using new tech to see 300 years into the past

Recent attempts by researchers to locate Maronberg began in 2007, with more extensive geographic information systems mapping conducted in 2008. These digital, computer-based geographic programs allow researchers to store a range of geological data and model spatial patterns across vast terrains.

Pairing a historical map with a low-resolution elevation map from the U.S. Geological Survey, archaeologist Bo Ejstrud created a predictive model to assess the probable location of the Maroon settlement. He considered elevation, slope and colonial infrastructure to identify the most remote areas of St. Croix with the least visibility from colonial lines of sight.

Back in the 1700s, urban centers accounted for only a small percentage of the overall landmass of the 83-square-mile (215-square-kilometer) island. Much of the land was either plantations or uninhabited forests and mountains. Ejstrud’s model reaffirmed the likelihood of a Maroon settlement in the northwest region. But it left us with a massive survey area. The map also didn’t account for the possibility that the settlement moved over time.

In 2020, I teamed up with archaeologists Steven Wernke, from Vanderbilt University’s Spatial Analysis Research Laboratory, and Lauren Kohut, from Winthrop University’s Geospatial Environmental Modeling Lab. Together, we developed and visualized a more dynamic model using advances in mapping since 2008.

We began by digitizing two of the most detailed colonial maps of St. Croix – one from 1750 and another from 1799. These maps, created by Danish military engineers and surveyors, detail the spread of plantations, roads and settlements over time.

Next, in order to build a digital elevation model of the island’s terrain, we incorporated high-resolution light detection and ranging, or lidar, data collected by the National Oceanic and Atmospheric Administration. Whereas traditional digital elevation models can be skewed by dense vegetation and trees, lidar uses laser pulses that penetrate through the forest canopy to map the Earth’s surface. This technology allows us to analyze some of the most secluded, inaccessible areas on the island. Prior to 2013, lidar was too costly for archaeological research purposes. But these days, it’s built into many cellphones.

By layering these datasets in geographic information systems software, we created a suitability model that estimated where Maroon settlements were most likely to have existed. In addition to isolation and visibility, we also incorporated accessibility to water sources and terrain ruggedness to model the degree of mobility through the landscape.

This approach allowed us to simulate how the opportunities and constraints the landscape offered to people seeking refuge shifted as colonial society grew over time.

Mapping changes

In addition to providing more nuance to the picture of the areas where Maroons potentially settled, our research suggests that the Maroon settlement wasn’t static, but likely waned as colonial infrastructure increased on the island. Our model implies that the area of suitable land for clandestine Maroon communities shrank by more than 90% in just 50 years.

It’s possible that over time there were fewer runaways. More likely, more Maroons left the island by boat for destinations such as Puerto Rico and Tortola.

Where we go from here

Though our findings still don’t provide an exact location for Maronberg, they get us one step closer to locating the physical remains of this centuries-old Maroon community. The next step will be to visit these sites and survey them for evidence of historical settlement. Archaeological research at these sites would help us understand more about the Maroons who turned a rugged landscape into a sanctuary for freedom.

Ultimately, identifying artifacts and historical sites within the newly established U.S. Virgin Islands Maroon Territorial Park would help us develop educational tours and honor the Maroon legacy.

Justin Dunnavant does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Escaped slaves on St. Croix hid their settlements so well, they still haven’t been found – archaeologists using new mapping technology are on the hunt – https://theconversation.com/escaped-slaves-on-st-croix-hid-their-settlements-so-well-they-still-havent-been-found-archaeologists-using-new-mapping-technology-are-on-the-hunt-237291

Source: The Conversation – USA (2) – By Charlotte Rogers, Associate Professor of Spanish, University of Virginia

As university leaders work to make deals with the Trump administration, many college presidents are at an ethical crossroads. On the one hand, they must do all they can to restore funding for vital research. On the other, they risk ceding to the demands of a president with views that don’t align with their missions.

As the fall semester begins, academic administrators could look to literature for guidance. Latin America’s rich archive of fiction over the past century features this dilemma in numerous stories about living under dictatorships.

Among many others, Peruvian novelist Mario Vargas Llosa, Colombian writer and journalist Gabriel García Márquez and Argentine author Luisa Valenzuela have mined the region’s turbulent political history to explore how authoritarian rulers bend institutional leaders to their will by cultivating fear.

Lessons from the bookshelves

In these works, some threats are more overtly coercive than others.

Vargas Llosa’s “The Feast of the Goat” details how Dominican dictator Rafael Trujillo reportedly fed insubordinate underlings to voracious crocodiles, an image that, for me, has echoes in Florida’s Alligator Alcatraz. In García Márquez’s “The Autumn of the Patriarch,” an illiterate strongman takes over all institutions to such an extreme that “él solo era el gobierno” – he alone was the government.

Yet to me, the greatest danger that Latin American literature foretells for higher education is the insidious way capitulation to authoritarians changes both individuals and institutions.

This is the subject of “The Censors,” a 1976 short story by Valenzuela. Back then, all but four Latin American countries were dominated by authoritarian regimes.

The main character in Valenzuela’s story is an average Joe – aptly named Juan – who writes a letter to his beloved Mariana, now living in Paris. Soon after he mails the letter, Juan is beset by fear that despite its innocuous sentiments, his message will be construed by authorities as subversive. He worries that secret military forces will fly to Paris and kidnap Mariana from her apartment. (Masked men forcing people into unmarked vehicles is a common sight in dictatorships, then and now.)

Juan decides he must “sabotage the machinery, throw sand in its gears.” So he becomes a censor for the regime in hopes of intercepting his own letter as it works its way through the painfully slow Post Office Censorship Division.

University leaders, much like Juan, begin with the best of intentions. They initially collaborate with the government’s demands because they want to protect the university’s mission.

But once the concessions are made, things begin to change.

In “The Censors,” Juan discovers he has a knack for redacting questionable letters. Assigned to a division that checks correspondence for explosives, he watches as a co-worker’s right hand gets blown off. Yet when a colleague tries to organize a demonstration advocating for safer working conditions, Juan reports him to the authorities and is rewarded with a swift promotion.

Juan justifies his opportunism as a one-off rather than a personal transformation: “Una vez no crea hábito” – “One time doesn’t create a habit” – he reassures himself as he leaves his boss’s office.

As he reaches the highest echelons of the censorship authority, Juan’s sense of purpose blurs beyond recognition. He now considers flagging subversive letters and condemning their authors to be “a truly patriotic task, both self-sacrificing and uplifting.”

At this exact moment, Juan encounters his own letter to Mariana. “Naturally,” the narrator declares acidly, “he censored it without regret.” In the last lines of the story, the narrator reveals that Juan was executed the following day.

Juan, Valenzuela concludes with devastating irony, is “one more victim of devotion to his work.”

Universities in the crosshairs

In his zeal to capitulate, Juan deals himself a death blow, and I can’t help but wonder if universities are heading down the same perilous path.

In an official statement, Brown University noted on July 30, 2025, that it will “comply with the Trump administration’s vision” on admissions practices. Likewise, Columbia University has agreed to direct governmental oversight of its Middle East studies department, while the University of Pennsylvania will no longer allow trans women on female sports teams.

At the University of Virginia, where I’m an associate professor of Spanish, President James E. Ryan resigned under intense pressure from the Department of Justice in June 2025.

For most of his seven years in leadership, Ryan set out to make the university more diverse and open doors for first-generation and low- to middle-income students.

By the time of his resignation, however, the university had already yielded to demands from a conservative alumni group to de-emphasize the history of enslavement during campus tours. And it had adopted “institutional neutrality,” meaning it would no longer take a position on, say, mass starvation in Gaza.

In March 2025, the university’s governing board voted to dismantle the university’s diversity, equity and inclusion office at the behest of Virginia Gov. Glenn Youngkin.

Three months later, Ryan was gone.

More to come?

As the White House continues its pressure campaign, academic administrators may face more funding threats in the future. I worry that if humanities programs are cut – the University of Chicago just paused admissions to doctoral programs in literature, philosophy, the arts and languages, citing “this moment of uncertainty” – students will lose the opportunity to be introduced to works like “The Censors.”

Columbia maintains it has safeguarded academic freedom by making a deal. But as Wesleyan University President Michael Roth told PBS, the academic community remains skeptical about the durability of these agreements.

Perhaps some administrators believe, as Juan did, that “one time doesn’t create a habit.”

But higher education, I fear, is being swallowed by its leaders’ “devotion to their work.”

The perspectives in this article do not reflect the official position of the University of Virginia.

– ref. Latin American literature contains warnings for American universities that yield to Trump – https://theconversation.com/latin-american-literature-contains-warnings-for-american-universities-that-yield-to-trump-262679

Source: The Conversation – USA (3) – By Abigail Folberg, Assistant Professor of Psychology, University of Nebraska Omaha

President Donald Trump’s administration has dramatically reshaped health and medical research by rolling back federal funding from institutions that have diversity, equity and inclusion initiatives and by cutting federal funding for research projects that the administration considers related to DEI.

As of Aug. 20, 2025, the National Institutes of Health has terminated over 5,100 grants totaling over US$4.4 billion in research funding. Likewise, the National Science Foundation, which seeks among other things to advance the nation’s health, has rescinded over 1,700 research grants totaling over $1 billion in funding.

These terminations have disproportionately affected projects that study the experiences of marginalized groups and funding to scientists from social groups that are underrepresented in academia. The federal judge overseeing a case challenging cuts to NIH grants said that he had “never seen government racial discrimination like this.”

Many Americans may view these cuts to health-related research as disconnected from the health care they receive. However, as a psychologist and a chemical engineer who study how gender and racial inequality affect well-being and the incidence and progression of disease, we believe that these changes will make all Americans less healthy.

Health repercussions for minority groups

The Trump administration’s funding cuts will most directly affect the health of members of marginalized groups, including, but not limited to, people of color, women and people who identify as lesbian, gay, bisexual, intersex and transgender. The website grant.witness.us includes a list of the project descriptions of canceled grants. The NIH grants that were terminated include ones that funded research investigating the effects of food insecurity and stress on prenatal and birth outcomes among women of color, sex differences in major depression, and risk factors for suicidal behavior among gender minority adolescents.

The White House has also indicated that it intends to ax the National Institute on Minority Health and Health Disparities, which funds research on groups that tend to have poorer health outcomes, in its planned reorganization of the NIH.

These cuts will likely make these groups’ health outcomes worse. One of the reasons for these health disparities is that the health experiences and outcomes of members of marginalized social groups, such as women of color, have historically received less attention. Health disparities cannot be closed without high-quality research.

The case of endometrial cancer

One example of a disease where differences in health outcomes vary depending on race is endometrial cancer. The endometrium is an inner layer of the uterus, and endometrial cancer therefore primarily affects women. As we discussed in a 2023 review article, Black women are more likely than white women to have worse disease outcomes and to die from endometrial cancer. Some of the reasons for these disparities are unclear. For example, researchers do not know why Black women are more likely to get the more aggressive of two subtypes of endometrial cancer. This knowledge gap underscores the need to study these disparities.

But many causes of these disparities are known – and they are social in nature. For example, researchers discovered that Black women were less likely than white women to know about the early warning signs of endometrial cancer, such as postmenopausal vaginal bleeding. Black women were, therefore, more likely to be diagnosed later and die from endometrial cancer. Additionally, many Black women use chemical hair straightening kits, or perm kits, which have recently been linked to endometrial cancer incidence.

Also, Black patients and members of other groups, such as LGBTQ people and women, also routinely experience discrimination from health care providers. For example, studies suggest that some providers may fail to provide the best possible medical care and express discriminatory attitudes toward Black and sexual minority patients, which may prompt patients to avoid seeking future medical care. More generally, the stress from experiencing discrimination can also lead to physiological changes in the body that contribute to poorer physical and mental health.

Addressing social factors that influence health

DEI initiatives may address some of these social factors. For example, efforts to promote diversity among medical professionals may be beneficial because patients of color may experience better outcomes when they are treated by doctors who share their racial or ethnic identity, and more diversity among primary care physicians may reduce racial health disparities. Black patients are also more likely to trust their providers when their providers signal awareness of systemic inequality – and trust, in turn, may encourage people to make use of preventive health services such as routine checkups.

Medical care is also supported by scientists from many disciplines who research the progression and treatment of disease. These researchers’ identities may influence what they choose to study and how they choose to study it. DEI initiatives, such as peer-mentoring programs and intentional efforts to recruit diverse faculty, help institutions to recruit and retain people whose backgrounds and experiences are traditionally underrepresented in academia. Better representation across many scientific fields may also contribute to the research and training of physicians and other scientists who contribute to the health of the nation.

Diversity in health care benefits everyone

Slashing support for DEI initiatives in health care as well as funding for minority health is likely to reshape the health of all Americans, not just people of color and others from underrepresented groups.

For example, the government has scrubbed the mention of words that are associated with DEI, such as “women,” “Black” and “bias” from federal agencies and has increased scrutiny of grants submitted to the NIH and the National Science Foundation. Among the canceled grants was research examining women’s reproductive health, which affects both women and anyone who wishes to become a parent, regardless of whether they carry or birth that child.

Other canceled research grants examined ways to reduce the incidence of new HIV/AIDS infections among transgender women and men of color. Although this research specifically examined transgender people, research on reducing the transmission of HIV is a key strategy for eradicating HIV/AIDS, which affects about 1.2 million people in the U.S. and about 40.8 million people worldwide.

Moreover, because trainees from many different research areas were supported by grants that support biomedical researchers from underrepresented groups, canceling those grants has curtailed the study of diseases that affect many people. For example, these cuts have hit research on Parkinson’s disease, which is rising in prevalence and affects more men than women.

Health disparities also have profound economic costs – and poorer care for people from marginalized social groups result in costs that are borne by everyone. A 2018 study, for example, estimated that in 2018 alone, racial health disparities cost society $421 billion to $451 billion in excess medical care expenses, lower labor force productivity and premature death. The same study estimated that health disparities among those who did and did not have a college education cost between $940 billion and $978 billion.

Abundant evidence shows that improving the nation’s health requires medical research and education that broadens participation in science and attends to the health and well-being of all Americans, including those whose experiences were historically overlooked in the biomedical and psychological sciences. In our view, a more inclusive and pluralistic vision of science and health care is the best way to promote better health care for all.

Abigail Folberg receives funding from the National Science Foundation. This article reflects her views and does not necessarily represent the views of the University of Nebraska at Omaha.

Brittany Givens Rassoolkhani receives funding from The Alfred P. Sloan Foundation and the National Institutes of Health. This article reflects her views and does not necessarily represent the views of the University of Kentucky.

– ref. How stripping diversity, equity and inclusion from health care may make Americans sicker – https://theconversation.com/how-stripping-diversity-equity-and-inclusion-from-health-care-may-make-americans-sicker-249674

Source: The Conversation – USA (3) – By Kristen Demoruelle, Associate Professor of Rheumatology, University of Colorado Anschutz Medical Campus

Only a few decades ago, a diagnosis of lupus could mean giving up the dream of having children. Women with systemic autoimmune diseases like lupus were warned that pregnancy was too risky – both for them and their unborn babies. Fast forward to today, and the story is remarkably different.

Thanks to scientific research and medical advances, pregnancy outcomes have greatly improved over the past several decades, and the outlook for pregnancy in people with autoimmune disease is more hopeful than ever.

However, pregnant women with autoimmune diseases still face a far higher likelihood of having serious complications, including preterm birth or even fetal loss. So while the outlook has improved, navigating pregnancy with these conditions still comes with a unique set of challenges and considerations. This is due to the medicines used to treat the disease, the effects of inflammation on the body and imbalances of the immune system, including some that researchers like me don’t yet fully understand.

I’m a rheumatologist and biomedical researcher with medical training and expertise in rheumatology and reproductive health. Rheumatology is a medical specialty that treats people with systemic autoimmune and inflammatory diseases, like the ones discussed in this article. We’re sometimes thought of as arthritis doctors, but systemic autoimmune diseases can involve the whole body, and we care for all of those effects.

I think it is essential that women with autoimmune diseases are equipped with a realistic understanding of their potential pregnancy journey – both the advances that have made motherhood more possible for them and the risks that still remain.

Autoimmune diseases disproportionately affect women

Systemic autoimmune diseases are chronic medical conditions in which the immune system, which normally protects the body from infections, mistakenly attacks the body’s own tissues. These conditions can include lupus, rheumatoid arthritis and antiphospholipid syndrome, to name a few.

Some autoimmune diseases attack only one part of the body. For instance, the thyroid is the only part of the body targeted in a disease called Hashimoto’s thyroiditis. But in systemic autoimmune diseases, the immune system can attack multiple parts of the body, like the skin, lungs and kidneys in those with lupus.

Autoimmune diseases disproportionately affect women. Lupus, for instance, occurs nine times more often in women than in men, and rheumatoid arthritis is three times more common in women. Since many women are diagnosed with these conditions in their 20s and 30s, when women are in their prime childbearing years, pregnancy can introduce new and unexpected challenges to their health care.

Increased pregnancy complications

Preeclampsia – a high blood pressure complication of pregnancy – preterm birth and stillbirth all occur at higher rates in women with autoimmune diseases. This is especially true for women with lupus and a condition called antiphospholipid syndrome. Women with these autoimmune disorders are five times more likely to experience these complications.

Autoimmune diseases are also linked to higher rates of miscarriage and postpartum depression.

Some women with lupus and a condition called Sjogren’s syndrome have an antibody in their blood that can cross the placenta and cause a rare but serious congenital heart condition. Studies have also found higher rates of autism spectrum disorders in women with autoimmune diseases.

Testing and early planning can improve outcomes

Fortunately, thanks to advances in research and medicine, doctors and researchers like me now have helpful tools to assess a woman’s individual risk. This allows people with autoimmune diseases to better understand and manage their health before getting pregnant.

Pregnancy and the postpartum period can sometimes lead to remission, which is a time when inflammation and the disease are quiet, and sometimes lead to flares, or flare-ups, when inflammation increases and the disease is very active. Importantly, women who conceive while their autoimmune disease is quiet, rather than during a flare, have healthier pregnancies. By waiting for a time when one’s autoimmune disease is in remission, a woman can improve her chances of a healthy pregnancy.

Certain blood tests can also give clues about a person’s risk for pregnancy complications. For example, a positive test for lupus anticoagulant, a blood test that looks for certain proteins that can increase the risk of blood clots, can identify women at the highest risk for preeclampsia, preterm birth and fetal loss.

Some women also have antibodies that target proteins inside their cells, called Ro, which are often found in people with Sjogren’s syndrome. If a pregnant person has high levels of anti-Ro antibodies, they are at risk for a serious pregnancy complication called fetal heart block. The good news is that certain medications can lower these risks in women who have these antibodies.

Medications and pregnancy

Researchers and rheumatologists like me also better understand how medications affect pregnancy, in both harmful and helpful ways.

Several medications that are commonly used to treat autoimmune diseases can harm a developing baby or reduce fertility. If a pregnancy is being planned, these medications must be stopped ahead of time and replaced with pregnancy-safe medications.

In cases of unplanned pregnancy, stopping potentially harmful medications quickly can be critical. For those not planning pregnancy, using effective birth control is an important safeguard. Notably, contraception choices can also be influenced by a woman’s underlying autoimmune disease and should be discussed with the person’s rheumatologist or other specialists.

On the other hand, some medications can improve pregnancy outcomes in people with autoimmune diseases. For example, a medication called hydroxychloroquine can reduce the risk of anti-Ro antibody-mediated fetal heart block. Low-dose aspirin taken during pregnancy can lower the risk of preeclampsia.

And recently, a study found that a drug named certolizumab improved pregnancy outcomes in women with antiphospholipid syndrome, which is an autoimmune condition with high rates of pregnancy complications.

Historically, pregnant women were excluded from research studies, but this is starting to change, which could lead to safer pregnancies for those with autoimmune disease.

Looking ahead

With all this in mind, it’s important for people with systemic autoimmune disease to talk with their rheumatologist or other specialists when thinking about pregnancy and throughout the process. Planning ahead gives the best chance for a healthy pregnancy.

Still, even with careful planning, autoimmune disease flare-ups can happen during pregnancy, and treating them promptly is important for both the mom and the baby.

Ongoing care after delivery matters, too, as postpartum flares can interfere with a mother’s ability to care for her newborn. Fortunately, there are safe options available to treat flare-ups during pregnancy or breastfeeding.

Talking to your doctor

With better treatments and growing knowledge, most women with autoimmune disease are now having healthy pregnancies and thriving babies. Fertility options like in vitro fertilization are also safe for many with autoimmune diseases.

Some helpful questions to consider asking your rheumatologist include:

• What should I expect if I want to get pregnant?
• Is my disease under control enough to try for pregnancy now?
• Are my current medications safe if I become pregnant?
• Do I need to stop or start any medications before trying to conceive?
• What are my chances of having a healthy pregnancy?
• What are the possible complications I could face during pregnancy?
• What treatment options would I have if my disease flared up during pregnancy or after delivery?
• If I need to wait to get pregnant due to active disease, how long should I wait, and what contraception is best in the meantime?

The American College of Rheumatology and the European Alliance of Associations for Rheumatology offer clear, evidence-based recommendations for pregnancy.

There are also clinical tools available to rheumatologists and resources available to patients to help guide safe, personalized reproductive health care.

I believe it’s essential to have a care team that’s comfortable guiding you through these decisions, and it’s always OK to ask questions or explore additional resources.

Kristen Demoruelle receives research funding from the National Institutes of Health, Boehringer Ingelheim, and Bristol-Myers Squib for research projects that are unrelated to the topics in this article.

– ref. Pregnancy brings unique challenges for people with autoimmune diseases – but with early planning, pregnancy outcomes can be greatly improved – https://theconversation.com/pregnancy-brings-unique-challenges-for-people-with-autoimmune-diseases-but-with-early-planning-pregnancy-outcomes-can-be-greatly-improved-254359