Autoimmune diseases predominately affect women and commonly occur during the child-bearing years. Importantly, the diagnosis of an autoimmune disease should not preclude the opportunity to live a complete, fulfilling life—including family life. Fifty years ago, women with lupus were told by their doctors not to become pregnant for fear of maternal health. Now researchers know differently: women with lupus can and do have healthy pregnancies. However, pregnancies in women with lupus do have higher rates of complications than do those of women without lupus. Many of these risks can be minimized by careful management of the disease and medication use prior to becoming pregnant as well as during pregnancy.
While much has been describe regarding the possible complications of pregnancy in women with lupus, including flares of disease and preterm delivery, pregnancies in women with other underlying autoimmune diseases such as rheumatoid arthritis and multiple sclerosis have been less well studied. This is, in part, due to reports that these underlying diseases tended to improve during pregnancy, only to flare in the first few months after delivery. However, further studies have shown that more women with rheumatoid arthritis had active disease during pregnancy than had been previously thought, and that active disease during pregnancy may increase risks of preterm delivery and lower birthweight infants.
Because pregnancy leads to inherent changes in the immune system to allow for the growth of a foreign body (the baby), it seems natural these changes are likely to affect underlying autoimmune diseases. We are studying the immunological changes of normal pregnancies as well as those in women with autoimmune diseases, in order to gain insight into the immune system itself, as well as autoimmune diseases. We strongly believe that strategies can be developed to improve the outcomes of all pregnancies, especially those in women with underlying autoimmune diseases.
One common feature of autoimmune diseases is the inherent immune dysregulation that occurs even in the absence of immunosuppressive and immunomodulating therapies used to manage disease. Although similar immunosuppressive medications may be effective for different autoimmune diseases, the intricacies of immune dysregulation are often very specific to certain disorders. We are interested in studying the behavior of the altered immune system caused by these diseases and focus on the underlying immune response to immunological challenges that are commonly encountered. The two main interests of our group are: 1) the immunological response to pregnancy, where the immune system has to adapt to support the growing semi-allograft fetus; and 2) the immunological response to viral infection and vaccination, particularly with the varicella zoster virus.
Using epidemiological and translational approaches, we are studying the behavior of different autoimmune diseases during pregnancy as well as the outcomes of pregnancies among women with various diseases, including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and multiple sclerosis. These diseases commonly affect women during the childbearing years. We provide clinical care to women with these diseases who are pregnant or are considering pregnancy in the future. This often involves judicious use of immunosuppressive medications to control disease activity.
In general, it is thought that women with lupus may have increased rates of flares while women with rheumatoid arthritis and multiple sclerosis seem to have improvement in disease activity during pregnancy. We have discovered that thrombocytopenia at the time of conception may increase the risk of preeclampsia among women with lupus, and have identified an increased risk of preterm delivery and intrauterine growth restriction among pregnant women with rheumatoid arthritis. Our research focuses on better understanding why autoimmune diseases can behave so differently during pregnancy and to try to identify biomarkers that may better predict pregnancy complications like preeclampsia, prematurity, and fetal growth restriction.
In addition to pregnancy, our lab has recently become interested in understanding susceptibility to varicella zoster infection (chicken pox) and reactivation (shingles) as well as response to the shingles vaccine. People with autoimmune diseases appear to have increased incidence of shingles compared to healthy people of the same age. Use of immunosuppressive medications does not appear to explain all of the increased risk. We are studying immunologic factors that may explain the increased risk, as well as assessing the efficacy and immune response to vaccination to try to protect patients against shingles reactivation.
B.A., New York University, (valedictorian), 1992
M.D., The Johns Hopkins University School of Medicine, Baltimore, MD, 1997
M.S. in epidemiology, Stanford University School of Medicine, Stanford, CA, 2005
Honors and Awards
1991 Phi Beta Kappa, New York University
1991 Phi Lambda Upsilon National Honor Society, New York University
1991 George Granger Brown Scholars Award for Excellence in Chemistry, New York
1991 Lillian Lindhard-Solotoroff Prize for Excellence in Chemistry, New York University
1992 Roland P. Beattie Valedictorian Award, New York University
1992 Arthur E. Hill Prize for Excellence in Chemistry, New York University
1998 Santa Clara Valley Medical Center Department of Emergency Medicine Intern of the
2000 Santa Clara Valley Medical Center Department of Medicine Resident of the Year 1999
2000-01 Chief Resident Santa Clara Valley Medical Center
2002 Nominated for Fellows Teaching Award, Stanford University
2003 Nominated for Fellows Teaching Award, Stanford University
2004 Katherine McCormick Fund Travel Grant
2004-07 Center for Clinical Immunology at Stanford (CCIS) Faculty Fellowship Award
2005 American College of Rheumatology Health Professional Preceptorship Award
2006 Faculty Teaching Award, Division of Immunology and Rheumatology, Stanford University
2006 Elaine Lambert Fellowship Award for Research in Lupus
2010 Stanford University School of Medicine Faculty Fellow
Joined OMRF's Scientific Staff in 2011
Mariette X, Förger F, Abraham B, Flynn AD, Moltó A, Flipo RM, van Tubergen A, Shaughnessy L, Simpson J, Teil M, Helmer E, Wang M, Chakravarty EF. Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacokinetic study. Ann Rheum Dis. 2017 Oct 13. pii: annrheumdis-2017-212196. PMID:29030361
Shirley E, Chakravarty EF. The Herpes Zoster Vaccine in Rheumatic Diseases: Duration of Response. J Rheumatol. 2017 Jul;44(7):968-969. PMID: 28668813
Heinlen L, Chakravarty EF. Reproductive Health Screening in Women with Autoimmune Diseases. Rheum Dis Clin North Am. 2017 May;43(2):161-71. Review. PMID: 28390560
Chakravarty EF, Martyanov V, Fiorentino D, Wood TA, Haddon DJ, Jarrell JA, Utz PJ, Genovese MC, Whitfield ML, Chung L. Gene expression changes reflect clinical response in a placebo-controlled randomized trial of abatacept in patients with diffuse cutaneous systemic sclerosis. Arthritis Res Ther 17:159, 2015. [Abstract]
Kattah NH, Newell EW, Jarrell JA, Chu AD, Xie J, Kattah MG, Goldberger O, Ye J, Chakravarty EF, Davis MM, Utz PJ. Tetramers reveal IL-17-secreting CD4+ T cells that are specific for U1-70 in lupus and mixed connective tissue disease. Proc Natl Acad Sci U S A 2015. [Abstract] EPub
Segan J, Staples MP, March L, Lassere M, Chakravarty EF, Buchbinder R. Risk factors for herpes zoster in rheumatoid arthritis patients: The role of tumor necrosis factor alpha inhibitors. Intern Med J 2015. [Abstract] EPub
Chakravarty EF, Murray ER, Kelman A, Farmer P. Pregnancy outcomes after maternal exposure to rituximab. Blood 117:1499-1506, 2011. [Abstract]
Kelly VM, Nelson LM, Chakravarty EF. Obstetric outcomes in women with multiple sclerosis and epilepsy. Neurology 73:1831-1836, 2009. [Abstract]
Chakravarty EF, Khanna D, Chung L. Pregnancy outcomes in systemic sclerosis, primary pulmonary hypertension, and sickle cell disease. Obstet Gynecol 111:927-934, 2008. [Abstract]
Arthritis & Clinical Immunology Research Program, MS 50
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