Metabolic-immune axis in pregnancy: Implications for women with autoimmune diseases

A healthy pregnancy involves a series of physiological adaptations in both the immune and metabolic systems, which interact closely through the "metabolism-immune axis." Metabolic remodeling during pregnancy dynamically modulates immune cell functions, thereby promoting maternal tolerance to the semi allogeneic embryo. This adaptive crosstalk within the metabolism-immune axis is important for maternal health and fetal development throughout gestation and the perinatal period. However, in autoimmune diseases (AID) such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), this finely tuned axis may be intrinsically dysregulated or further altered by pregnancy, ultimately affecting disease activity and pregnancy outcomes. While current management strategies-including immunosuppressants, antimalarials, and anticoagulants-have improved outcomes to some extent, they often fall short in fully mitigating risks or balancing maternal disease control with fetal safety. This review aims to summarize current research advances regarding metabolic and immune remodeling in pregnant women with autoimmune diseases, such as SLE and APS, and proposes that targeting the metabolism-immune axis may hold important potential for improving pregnancy management in these patients.