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 To Have A Successful Pregnancy With Lupus
Systemic lupus erythematosus is an autoimmune disease which is found to affect more women, especially those in their childbearing years. While this long-term condition does not reduce the chances of conception, it does make a pregnancy high-risk due to potential complications that can affect the health of both mother and child. This includes an increased likelihood of miscarriage, premature delivery, preeclampsia and congenital heart disorders in the baby.Thanks to technological advancements in modern medicine, many women with lupus go on to have successful pregnancies and healthy babies. The key lies in careful planning and close monitoring with a rheumatologist and obstetrician to ensure the best possible outcome.Below are some tips to consider if you have lupus and are planning to build a family.
Preeclampsia Versus Lupus Flare
One of the most challenging clinical conundrums is differentiating SLE flare from pre-eclampsia. This is particularly so because up to 20% of lupus pregnancies are complicated by pre-eclampsia. This differentiation is not merely academic as pre-eclampsia is treated with immediate delivery whereas lupus flare is managed with immunosuppression. While both conditions can present with hypertension and proteinuria, urinalysis in pre-eclampsia is less likely to reveal an active sediment than in SLE flare. Thrombocytopenia is common to both but elevations of liver function tests are more suggestive of pre-eclampsia. In lupus flares, lower white blood cell counts, complement levels, and uric acid are seen than in pre-eclampsia.30,31
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What Effects Can Lupus Have On The Baby
Most lupus patients give birth to healthy babies. Babies born to lupus patients have no greater chance of birth defects or mental retardation than those born to women without lupus.
Among lupus patients with anti-Ro/SSA or anti-La/SSB antibodies, the risk that the baby will have neonatal lupus erythematosus is 25%. Neonatal lupus consists of a temporary red, raised rash and abnormal blood counts the disease usually disappears by 6 to 8 months of age and does not recur.
Among lupus patients with anti-Ro/SSA or anti-La/SSB antibodies, the risk that the baby will have congenital heart block is less than 3%. Thus, if you carry these antibodies, your obstetrician will regularly check the baby’s heartbeat starting at around your 16th – 18th weeks and continuing through 26th week of pregnancy. Depending on of the type of heart disease your baby has, your doctor may prescribe steroids to you in order to improve the outcome for your baby.
Babies of lupus patients are also prone to intrauterine growth retardation and low birth weight. This is more likely to occur in pregnancies where the mother is either taking steroids or suffering from pre-eclampsia, hypertension, or active disease. Therefore, it is important to undergo regular ultrasound monitoring to detect IUGR in time and manage it appropriately.
How Can I Tell If The Changes In My Body Are Normal During Pregnancy Or A Sign Of A Flare
You may not be able to tell the difference between changes in your body due to pregnancy and warning signs of a lupus flare. Tell your doctor about any new symptoms. You and your doctor can figure out whether your symptoms are because of your pregnancy or your lupus. This way, you can help prevent or control any flares that do happen.
Pregnant women with lupus have a higher risk for certain pregnancy complications than women who do not have lupus. You may also have other problems that happen during pregnancy.
I have lupus and am pregnant. Will my baby be healthy?
Most likely, yes. Most babies born to mothers with lupus are healthy.
Rarely, infants are born with a condition called neonatal lupus. Certain antibodies found in the mother can cause neonatal lupus. At birth, an infant with neonatal lupus may have a skin rash, liver problems, or low blood cell levels.
Infants with neonatal lupus can develop a serious heart defect called congenital heart block. But, in most babies, neonatal lupus goes away after three to six months and does not come back.
Your doctor will test for neonatal lupus during your pregnancy. Treatment can also begin at or before birth.
Can I breastfeed if I have lupus?
Yes. Breastfeeding is possible for mothers with lupus. However, some medicines can pass through your breastmilk to your infant. Talk to your doctor or nurse about whether breastfeeding is safe with the medicines you use to control your lupus.
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Will I Need To Change My Treatment Before Pregnancy
This depends on which medicines you take and how well controlled your illness is. Good control for at least three to six months before getting pregnant is ideal. An unplanned pregnancy can put both you and the pregnancy at risk.
If your lupus has been poorly controlled, or if it affects major organs such as the heart, lungs, or kidneys, you may be counseled to avoid pregnancy, at least for a while, or to change medicines to better control your disease.
Some medicines taken for lupus are unsafe for a developing baby, and are generally avoided during pregnancy. Examples include methotrexate, mycophenolate, and cyclophosphamide. But the health and well-being of the mother must also be considered, since changing medications could put the mothers health at risk. With advance planning and coordination among your doctors, you can make changes to improve treatment safety.
Is It Possible For A Mother With Lupus To Breastfeed Her Baby
Yes, most women with lupus are able to breastfeed their babies. The American Academy of Pediatrics recommends that infants be exclusively breastfed for six months and continued breastfeeding until one year. Be patient, as it often takes time for the mother and baby to learn how to breastfeed. Do not hesitate to seek help from your doctor or nurse if you face trouble while breastfeeding. Nonetheless, lupus mothers may face the following challenges with regard to breastfeeding:
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Key Points To Remember
- Most patients with lupus can have successful pregnancies.
- Planning for pregnancy can reduce the risk of pregnancy complications.
- Important risk factors for pregnancy complications include active lupus, history of nephritis, and presence of antiphospholipid antibodies.
- Patients with a history of aPL pregnancy complications should be treated with low-dose aspirin and enoxaparin during pregnancy.
- Patients with positive anti-Ro/SS-A and anti-La/SS-B antibodies are at risk to have a child with neonatal lupus erythematosus, including a 2% risk of complete heart block, and should be monitored with serial fetal echocardiograms from week 16 to week 26.
- Lupus medications considered compatible with pregnancy include hydroxychloroquine, prednisone and prednisolone, azathioprine, cyclosporine and tacrolimus.
- Medications that should not be used during pregnancy include mycophenolate mofetil, methotrexate, and cyclophosphamide. Other medications have inadequate data for use in pregnancy.
When Is It The Right Time To Conceive And What Should You Do After Becoming Pregnant
The right time to conceive is when the lupus disease activity is fully under control and you are in your best health. The healthier you are before your pregnancy, the greater are your chances of having a healthy pregnancy and a healthy baby. It is strongly recommended that you avoid pregnancy until at least six months after the lupus disease activity, especially kidney disease, has been completely brought under control. Pregnancy places an added burden on your kidneys and active kidney disease can even lead to pregnancy loss. Because active lupus affects both the mother and pregnancy outcomes, monitoring lupus activity at least once every three months is usually recommended.
After your pregnancy test is positive, you should visit your rheumatologist and obstetrician at your soonest possible convenience. The purpose of these visits is to assess the state of your health and lupus disease activity by means of a complete physical examination and blood tests. Blood tests include pre-pregnancy or early pregnancy laboratory testing for relevant autoantibodies to improve counseling regarding pregnancy.
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How Does Lupus Affect Pregnancy
Whether and how SLE affects pregnancy isn’t absolutely clear, but it does seem that the women who do best are those who conceive during a quiet period in their disease. Those with the poorest pregnancy prognosis are women who get pregnant during a flare-up or have severe kidney impairment.Trusted SourceNational Institutes of HealthManaging Lupus Patients During PregnancySee All Sources Ideally, kidney function should be stable for at least six months before conception.
There are a number of increased pregnancy risks associated with lupus, including:
Even if your disease is in remission, lupus pregnancies are still classified as high risk, which means you’ll likely be assigned to a specialist who is familiar with these cases, and you’ll receive some extra tests at every prenatal visit. You’ll also have to visit the doctor more often: Most lupus patients check in with their practitioners every two to four weeks throughout pregnancy.
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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How Does Lupus Affect Your Unborn Baby
Most babies who are carried to term arent 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 didnt 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.
What Pregnancy Complications Am I At Risk For
Many people with lupus have healthy pregnancies. But lupus does raise your risk for several serious complications, including:
- High blood pressure, which can lead to a serious condition called preeclampsia
- Growth problems
- Premature birth
- Having a baby with neonatal lupus or heart block
Some people with lupus have antiphospholipid antibodies certain proteins in blood that can increase the risk of blood clots and miscarriage. If your blood tests show that you have these antibodies, your doctor may give you medicine to help prevent blood clots during pregnancy.
What is preeclampsia?
Preeclampsia is a serious blood pressure problem that happens during pregnancy. If its not treated early, it can cause other health problems including kidney damage, problems with blood clotting, and seizures.
People with lupus are at higher risk for preeclampsia and a related condition called HELLP syndrome. HELLP syndrome causes serious problems with the liver and blood.
Preeclampsia can be very dangerous but early treatment makes a big difference. Get help right away if you have any of these symptoms while youre pregnant:
- Blurry vision or sudden changes in your vision
- Severe headaches
- Severe pain in your upper abdomen
- Trouble breathing or severe shortness of breath
How can I prevent preeclampsia?
Taking low-dose aspirin every day may help lower your risk for preeclampsia. Talk with your doctor about taking low-dose aspirin during pregnancy.
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Caring For Yourself During Pregnancy
In addition to seeing your doctor regularly and following your treatment plan, there are many things you can do to care for yourself and your baby:
- Get plenty of rest. Plan for a good night’s sleep and take breaks throughout the day.
- Eat healthfully. Avoid excessive weight gain. Have your doctor refer you to a dietitian if needed.
- Avoid smoking and drinking alcohol.
- If you have any unusual symptoms, speak to your doctor right away.
Lupus And Pregnancy: Tips For Living With Lupus While Pregnant
Lupus does not reduce a womanâs chances of getting pregnant. Less than 50% of pregnancies in women with lupus have complications, but all lupus pregnancies are considered high-risk. Lupus can complicate pregnancy with an increased risk of miscarriage, premature delivery, and preeclampsia, as well as heart problems in the baby. If you have lupus and are considering having a baby, consider these tips to ensure a safe pregnancy and healthy baby.
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Effects Of Lupus On Fertility
Lupus might diminish a woman’s ability to conceive in a variety of ways:
Menstrual Disturbances. Active lupus might lead to irregular menstruation, including heavy bleeding or absence of a period, which may complicate conception.
Reproductive System Dysfunction. Severely uncontrolled lupus might impair reproductive organs, thus preventing egg fertilization or implantation.
Medication Side Effects. Certain lupus drugs might decrease libido and lead to premature ovarian failure and low ovarian reserve, both of which result in infertility.
Psychological Factors. Lupus-induced emotional distress might decrease libido and sexual function.
Other Associated Conditions, such as lupus nephritis or antiphospholipid antibody syndrome , both of which might lead to infertility.
It is important to note that a lupus-related pregnancy delay is an important factor contributing to infertility since ovarian reserve depletes with age, lessening the chances of getting pregnant.
Will I Get Extra Care During Pregnancy Because I Have Lupus
If you have lupus, you will be classed as having a high-risk pregnancy. This means that you will have extra care, including more scans than other pregnant women.
What care you have during your pregnancy will likely depend on how your condition affects you. Essentially, the more active your condition, the more closely monitored you and your baby will be.
If your condition is stable, you will probably be seen by specialists every month as well as have your routine antenatal care. These appointments will be used to check your blood pressure, kidney health and your babys growth pattern.
You may need to be seen more often if:
- your condition is active
- the doctors have found anti-ro, anti-la or APS antibodies if they have, your babys heart rate will be monitored regularly.
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What Are My Risks If I Have Lupus And Get Pregnant
Even with improvements in management over the years, the risks of pregnancy-related complications are still increased for lupus pregnancies when compared to the general population. However, recent clinical research has helped rheumatologists to identify patients who may have the highest risk of complications. Complications affecting pregnancies in women with lupus can include:
- Premature babies
- Small-for-gestational age infants
- Lupus disease flares that may damage the mothers organs or be life-threatening
- Higher-than-average risks of other pregnancy associated conditions, such as:
- Gestational hypertension
- Preeclampsia A condition that affects some women during pregnancy, this can involve gestational hypertension and other blood disorders, high protein in the urine and, in some cases, kidney and liver damage or dysfunction
- Eclampsia Seizures caused by the damage to the body described in preeclampsia above, this condition can lead to organ failure and other life-threatening complications