Lupus During Pregnancy: A Team Effort
Once youre pregnant, youll need regular check-ups to make sure youre staying healthy. Managing your pregnancy should be a team effort involving you, your Ob/Gyn and your rheumatologist, Dr. Pachaidee says.
Your team will do regular tests to look at your blood chemistry and organ function. Theyll also look for the presence of different types of antibodies that can cause trouble during pregnancy. These are:
- Antiphospholipid antibodies can interfere with the placenta and slow fetal growth.
- Anti-SSA/Ro and anti-SSB/La antibodies can cause neonatal lupus in the newborn.
If your doctor detects these antibodies or other problems, theyll monitor the pregnancy more closely to watch for complications.
How Can I Prevent Lupus Flare
The best bet for a safe pregnancy is to have your lupus well-controlled. And the best way to prevent a lupus flare-up before or during your pregnancy is to plan out your pregnancy with your healthcare provider. This conversation might feel uncomfortable at first, but its important. Speaking with your provider will allow you to get ahead of your symptoms. Studies show that there is a decreased chance of flare-ups if you are symptom-free for at least 6 months prior to conception.
Planning with your provider is also helpful for knowing what to do if you do experience a flare-up during pregnancy. For example, hydroxychloroquine is generally thought to be safe in pregnancy. Studies have shown that taking this drug is linked to fewer flare-ups and therefore fewer complications in pregnancy.
Remember that lupus flares during pregnancy can be very difficult to distinguish from normal pregnancy symptoms. In other words, any normal pregnancy symptom can mimic a flare including:
Thats why its important to contact your healthcare team if you have any concerning symptoms.
Before You Get Pregnant:
- Assemble your lupus health care team. Prior to getting pregnant, women with lupus should meet with a rheumatologist, a doctor who specializes in diseases like lupus, a perinatologist or high-risk obstetrician, and a pediatric cardiologist.
âPreconception counseling allows women who have lupus to discuss their personal health with their doctor to assess risks based on how lupus has affected her thus far,â says Larry Matsumoto, MD, maternal fetal specialist at Atlanta Perinatal Consultants. âNot all women are the same, so it is important to know what your lupus means for your pregnancy.â
Some pregnancies will require treatments early on. These treatments counteract risks of complications and should begin within the first few weeks of pregnancy for best results. The risk of complications is greater if you are having a lupus flare, so itâs important to work with your doctor.
- Determine your personal risk for pregnancy complications. Every lupus case is different. Lupus doesnât seem to increase the risk of first-trimester miscarriages. But women with lupus do have an increased risk of miscarriage later in pregnancy or even stillbirth because of anti-phospholipid and anti-cardiolipin antibodies. About 33% of women with lupus have these antibodies, which increase the risk of developing blood clots. Your doctor can recommend specific blood tests to check for the presence of the antibodies.
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Can Pregnancy Make Lupus Worse
Pregnancy may worsen already abnormal heart or kidney function and may increase risk of blood clots. Although the risk of a lupus flare is not increased in pregnant women when compared to non-pregnant women, lupus flares can occur during pregnancy or immediately following delivery. Fortunately most of these flares are not life threatening to the mother or the baby and can be treated with steroids.
Women who conceive at least six months after the lupus disease activity has been brought under control are less likely to experience a lupus flare than those who conceive while their lupus is active.
S You Can Take Before And During Pregnancy
Step 1: Work with your rheumatologist well ahead of time to plan your pregnancy
- Your doctor will work with you to develop a plan and to get your lupus under control before you get pregnant. Your doctor will also discuss any risks there may be for you or your unborn baby, review your medicines, and perform tests to ensure that it is safe for you to get pregnant.
Step 2: Try to be as healthy as possible when youre trying to get pregnant
- Research shows that pregnancy is safe for many women when their disease is inactive or is at a stable, mild-to-moderate level of activity.
- Its best to avoid pregnancy until your disease has been inactive for at least 6 months.
Step 3: Choose an obstetrician who has experience in high-risk pregnancies
- Once youre pregnant, its best to be under the care of a kind of obstetrician called a maternal-fetal specialist. These specialists have experience managing high-risk pregnancies. They will work with your rheumatologist throughout your pregnancy. If complications happen during your pregnancy, some obstetricians work together with a kind of doctor called a perinatologist. These specialists will care for both you and your unborn baby.
- All women with lupus should try to schedule their delivery at a hospital that has a neonatal intensive care unit . This is because the chance of giving birth before 37 weeks is higher in women with lupus than in women who do not have lupus.
Step 4: Continue to see your rheumatologist
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What Should Mothers With Lupus Do After The Delivery Of The Baby
After the delivery, it is essential to follow up regularly with your doctor for the monitoring of the normal changes in your body as it transitions to its pre-pregnant state.
Lupus patients might be vulnerable to disease flare postpartum. Lupus flares following delivery are treated similarly to those in a non-pregnant patient. However, if you are breast feeding you may have to stop doing so, depending on the type and the dosage of medications you require for your treatment.
Make sure you discuss the options for birth control with your doctor. Please remember that breastfeeding is not a reliable method of birth control.
Since lupus patients might face complications following delivery, it is important to arrange in advance for someone who will provide proper care to your baby while you are undergoing treatment.
Is It Possible For Lupus Patients To Have A Normal Vaginal Delivery
Women taking steroids usually require an increased dose during labor. The increased dose of steroids helps the body cope with the additional physical stress your body experiences during labor. Routine administration of stress-dose glucocorticoids at the time of vaginal delivery is not recommended, however it may be recommended for surgical delivery.
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Disease Activity During Pregnancy
One of the major issues is SLE pregnancy is the risk of disease exacerbation. Although it is generally agreed that pregnancy may lead to higher rates of disease flares, widely variable flare rates of between 25-65% have been reported . Different organ systems may have variable response to pregnancy musculoskeletal flares are less common while renal and hematologic flares are more common . Majority of the flares in pregnancy are mild-to-moderate, with only small percentage of patients developing severe flares . Active disease during the 6 months prior to conception, history of lupus nephritis and discontinuation of anti-malarial significantly increase the risk of flares during the pregnancy .
How Do You Treat Lupus During Pregnancy
If your SLE remains in remission throughout the course of your pregnancy, you’ll likely not need any special treatment during your nine months. If your lupus is active or if you experience a flare-up, however, your medical team will work with you to treat your disease in a way that’s safest for you and your growing baby. Just as the treatment for lupus is individualized for non-pregnant women, so too will your treatment be tailored to your specific needs during pregnancy.
At each appointment, your practitioner will perform a series of tests taking samples of your blood and urine, listening to your baby’s heartbeat and asking you about possible lupus symptoms to determine whether you need any additional treatment. Youll also receive more frequent ultrasounds.
If you have particularly high levels of lupus-related antibodies in your blood or have lost a previous pregnancy, for example, daily doses of aspirin and heparin may be prescribed.
Lupus is treated with a variety of other medications, both over-the-counter and by prescription. Speak with your doctor about the following treatments to determine the best ones for your particular case:
Other medications such as methotrexate and cyclophosphamide arent considered safe during pregnancy and should be discontinued before you conceive. If you experience fatigue, soreness or any other SLE symptoms , it’s best to call your doctor right away than to wait for your next appointment.
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Im Trying To Conceive: When Is The Best Time
There are no definitive guidelines however, Dr. DeLorenzo recommends making sure your last lupus outbreak has been under control for at least three months.
Many women believe pregnancy can cause a lupus flare-up, but studies show thats not the case. However, he reminds women that a flare-up during pregnancy can be very detrimental even fatal to the fetus, and therefore, your pregnancy will need to be monitored closely. Patients can flare with lupus, but the pregnancy itself doesnt necessarily cause a flare, he explains.
Am I At Higher Risk For Pregnancy Complications
Everyone with lupus has a higher risk of pregnancy complications. But some things may raise your risk even more, like:
- High blood pressure
- Kidney problems
- Problems with your blood, like blood clots or not having enough platelets
- Having a certain type of proteins in your blood that may increase your risk for blood clots and pregnancy loss.
Your risk is still higher if you had these problems in the past, even if you dont have them now. Your risk is also higher if you had complications during a past pregnancy.
Talk with your doctor about your risk for pregnancy complications and make a plan to help prevent them.
If you work closely with your doctors and wait to get pregnant until your symptoms are under control, you have an excellent chance of having a healthy pregnancy.
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How Lupus Affects Pregnancy
Lupus is a chronic condition that results from a malfunctioning immune system.
The immune system is designed to identify foreign bodies and attack them to keep us healthy. However, in the case of lupus, your immune system mistakenly attacks one or many different types of tissue in the body, such as the skin, joints, muscles, nerves, kidneys, heart or lungs. The result of this damage is ongoing inflammation and pain.
For these reasons, its important that you plan your pregnancy carefully.
The healthier you are before you get pregnant, the greater the chance that you will have a healthy pregnancy and a healthy baby. Aim to have your condition under control and be in the best possible health.
Talk with your doctor and specialist before you get pregnant. They may need to make important changes to your medication to ensure a safe pregnancy. Some medications are safe to take while youre pregnant however others, like methotrexate, shouldnt be taken. You may need to stop taking some medications months before trying to get pregnant as they can be harmful to your baby. Your doctors will help you plan this.
In some cases, there is a reduction in lupus symptoms during pregnancy. Your lupus is more likely to be stable throughout your pregnancy if your condition was stable before conceiving.
Signs That You Need To Call Your Doctor Right Away
If you have any of the following symptoms or new or unexplained symptoms, call your doctor right away. It could be a sign that something is wrong.
- Severe headaches.
- Blurred vision.
- Swelling in your feet, ankles, or legs.
- Signs of a lupus flare such as swelling in the knees, skin rashes, and hair loss . Note that these can be similar to normal body changes that happen during pregnancy. Your doctor can tell if youre having a flare or not.
Andrew Koenig, D.O., F.A.C.R., is a rheumatologist and the Inflammation/Immunology Group Lead for North America Medical Affairs at Pfizer, Inc.
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How To Know If You Had A Miscarriage
Signs and symptoms of a miscarriage can include:
- Vaginal spotting or bleeding
- Cramping or abdominal pain
- Fluid or tissue passing from the vagina
Some vaginal bleedingspecifically spotting early in pregnancymay not indicate a potential miscarriage. Regardless, contact your healthcare provider immediately if you experience these symptoms.
What About Breastfeeding
Can you breastfeed with lupus? For most women, the answer is yes. But you will need to avoid certain medications while breastfeeding because they can pass into breast milk and harm a baby, she says. If you need those medications to control lupus after the baby is born, you might need to stop breastfeeding.
A healthy pregnancy with lupus takes a little extra planning, but many women with the condition have given birth to healthy babies. Lupus is not something you can take lightly, Dr. Pachaidee says. But a safe pregnancy is possible.
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You’ve Saved This Page
Lupus, also called systemic lupus erythematosus or SLE, is an autoimmune disorder that can cause health problems during pregnancy. Autoimmune disorders are health conditions that happen when antibodies attack healthy tissue just about anywhere in the body by mistake.
Lupus and other autoimmune disorders can cause swelling, pain and sometimes organ damage. Lupus also can affect joints, skin, kidneys, lungs and blood vessels.
Lupus affects more than 160,000 people in this country. Women are more likely to have autoimmune disorders like lupus than men. It often develops in women of childbearing age and can affect a pregnancy. Fortunately, with the right care, you can still have a healthy pregnancy if you have lupus.
Do You Need Special Medical Care During Pregnancy
Yes. Your provider closely monitors your pregnancy so that any lupus flares or problems can be treated quickly. In general, you should be cared for by:
- High-risk obstetrician, a doctor who specializes in taking care of women with serious pregnancy complications
- Rheumatologist, a doctor who specializes in disorders having to do with inflammation or pain in muscles and joints
Most likely your baby will be born healthy, but you may want to plan to give birth in a hospital that is equipped to care for premature or sick babies.
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Lupus Treatments Can Affect Your Pregnancy
More than lupus itself, the treatments you take to control it may affect your ability to get pregnant or carry your baby full term. Chemotherapy can harm your ovaries, and corticosteroids can lead to high blood pressure, kidney problems, and diabetes, each of which complicates your pregnancy. If youre taking any medications for lupus and plan to get pregnant, you need a team of physicians who are experts in high-risk pregnancies like ours on your side.
Having lupus doesnt mean an end to your dreams of having a family, but it does mean you need to take special precautions for you and your baby. And if youre undergoing treatment for lupus now but arent ready to have children yet we can help you take steps to preserve your fertility in the future.
To learn more about lupus and how it impacts fertility and pregnancy, contact us at any of our locations in Hasbrouck Heights, Wayne, or Hoboken, New Jersey, today. Or schedule a telehealth appointment to talk to one of our specialists from the comfort of your own home. Just call 201-288-6330 or visit us at www.uranj.com.
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How Does Lupus Affect Your Unborn Baby
Most babies who are carried to term aren’t at risk of any additional conditions. There are no increased odds of birth defects, for instance. In fact, a 2015 study of women who became pregnant while their lupus was under control found that most had healthy, uncomplicated pregnancies as long as they didn’t experience certain risk factors .
As mentioned, complications can include an increased risk of preeclampsia, low birth weight and preterm birth, as well as more serious but rare conditions like neonatal lupus. About 3 percent of babies born to moms with lupus have a temporary form of lupus called neonatal lupus. This condition can range in severity, from just a facial rash or low blood cell count to more serious heart conditions.
Most of the time, the less serious symptoms in the baby disappear completely after six months. The more serious complication of congenital heart block, which causes a slow heartbeat, can be monitored during pregnancy and treated, if needed, after birth. After one case of neonatal lupus theres an 18 percent chance that itll occur in another baby, though the chance that your child will develop lupus in other forms in adulthood is extremely low.
Keep in mind that breastfeeding your baby if you have lupus is definitely possible, but be sure to consult your doctor before you begin. Some medications that youre taking to keep lupus at bay can pass through breast milk, so check each one to confirm that its safe.
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After Your Baby Is Born
Having lupus can be a challenge at the best of times, let alone without a small human to look after too! I felt great during pregnancy but did need a lot of support once my son was born, especially during bad days and flares.
You will probably be monitored and treated for any pregnancy-induced hypertension for a while after you give birth. Youll also be assessed for given treatment if required to prevent blood clots and kidney problems.
Your risk of your condition flaring up increases after you have a baby. So, you will need to be aware of how you feel and tell your doctor if you have any symptoms.