Pregnancy

Lupus and Pregnancy: Things to Keep in Mind

General information about Systemic Lupus erythematosus (SLE): SLE, often called simply lupus, is an autoimmune disease that causes chronic swelling (inflammation) and that damages bodily organs.  Over time, such damage can affect organ function, leading to severe health problems.  Some of the organs commonly affected are the skin, kidneys, heart and lungs. Many people with lupus also suffer from joint swelling, otherwise known as arthritis.

Lupus and pregnancy

Lupus can complicate pregnancy.  While most women suffering from lupus are able to conceive and to sustain a pregnancy, there can be challenges, and careful monitoring is needed to manage potential complications and to ensure the health of both mom and the baby to be.  If you are a woman with lupus contemplating pregnancy, here are some things to keep in mind and to discuss with your rheumatologist as soon as you start thinking about having a baby.

Medication

Think about your medication.  Many of the medications that work so for you to keep your lupus in remission will work against you during pregnancy, and many are not considered safe to continue taking during pregnancy.  Talk to your rheumatologist about each medication, and make a plan for weaning you off each one that needs to be stopped.  Consider replacement medications that are safer, and establish a pregnancy care plan.  If you have just discovered a surprise pregnancy, call your rheumatologist immediately to talk about whether or not to drop your medications immediately, without a step down period.  Try not to worry, though, if you were taking your medications before discovering the pregnancy.  In all likelihood, your little baby is just fine.  Set up a rheumatology appointment, and establish that care plan for the remainder of your pregnancy and for the post-partum period.  Also set up an appointment with an obstetrician (pregnancy doctor) to have an exam and an ultrasound, so you can both take a look at the baby.  It will certainly be reassuring to see (and maybe hear) the baby’s heartbeat!  Make sure that your rheumatologist and your obstetrician communicate about and collaborate on your care plan.

Remission and Flares

The best time to try for a baby is when your lupus is in remission.  If you are in a flare right now, put your baby fever on hold for a while and take all the necessary steps to get your lupus back under control.  As mentioned above, many of the medications used to manage lupus are not safe for pregnancy, and other medications will need to be substituted.  If you are in a flare and discover you are pregnant, or you flare after you find out you are pregnant, talk to your doctor, and plan with your partner ways to cut back on your daily activities and manage your stress.  You’ll need extra rest! Some women find that pregnancy sends active lupus back into remission, but many more find that pregnancy can stir up a flare.  If you have a care plan established with your doctors prior to conceiving, you should have preparations in place to manage the flare.  Most pregnancy induced flares are milder than a typical flare, especially if your lupus was in remission before conception.  Some facts and statistics on pregnancy and lupus flares:

  • Flares seem to be tied to estrogen production, though the reasons for this aren’t clear.  During pregnancy, a woman’s estrogen levels are elevated and can bring on a flare.
  • Pregnancy related flares are more common in women whose lupus affects their kidneys.
  • Up to 18% of pregnant lupus patients will suffer a flare during the pregnancy.

Risks to Baby

Beyond the risks associated with medication use, there are a couple other potential concerns

  • Neonatal Lupus.  Rarely, a baby born to a mother with lupus will also show antibodies for lupus, since the antibodies can cross the placenta.  About 1% of neonates born to mothers with lupus will show mild lupus symptoms.  Typically, the symptoms gradually disappear over the first few months of the baby’s life. In about 2% of those babies showing lupus symptoms, a condition called heart block develops.  Heart block causes a very serious, potentially fatal abnormal heart rhythm.  Your baby will need to have a pacemaker installed to correct this arrhythmia.  A good obstetrician should be aware of this tiny, tiny risk, and plan accordingly, but you may want to discuss the condition with him or her, especially if you find yourself worrying and stressing about it.
  • Intrauterine Growth Restriction (IUGR). IUGR refers to poor growth of the baby while you are pregnant.  While there are several causes of IUGR (including twin or other multiple pregnancies), the suspected reason for its occurrence in moms with lupus relates to the inflammatory effects of the disease.  Moms with lupus are also more likely to experience preeclampsia, a condition where blood pressure rises, and can cause complications for the mother and the baby.  Preeclampsia can cause IUGR, though IUGR certainly occurs without preeclampsia.  Up to 15% of infants born to mothers with lupus will show some degree of IUGR.  Many babies with IUGR will eventually “catch up” to their peers, though it may take many years before they do so.
  • Premature birth and the complications associated with prematurity, such as underdeveloped lungs, small size, and so forth. Tying in with the risks of preeclampsia is the risk of premature birth.  Mothers showing preeclampsia are monitored very closely, and if the condition worsens, the baby is typically delivered.  If the baby is born before 37 weeks gestation he is considered to be premature.  The implications of a premature birth relate directly to the gestational age of the baby, meaning that a baby born after 35 weeks of pregnancy will have fewer complications than will a baby born after 30 weeks of pregnancy.

The most important thing for you to remember as you plan for your pregnancy is to take good care of yourself.  Get your lupus under control, make a plan with your doctors, manage your medications, eat a healthy diet, get plenty of rest and keep a positive outlook!

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