Women with lupus can safely conceive and carry out a full-term pregnancy, and most will have a healthy baby. Even so, all women with lupus have a “high-risk” pregnancy. Meaning, various problems could arise if no action is taken before the pregnancy to ensure that lupus activity is stable. You should have frequent check-ins with your rheumatologist and gynaecologist during your pregnancy to monitor your condition and your baby’s development.
What Is Lupus?
Systemic lupus erythematosus, commonly known as SLE or Lupus, is a chronic autoimmune disease that causes inflammation and pain in any part of the body. Because it is an autoimmune disease, it directly affects the functions of the immune system, which are our bodies’ natural defences in fighting off infections. Instead, the system attacks healthy tissues. These occurrences can lead to many severe complications if not maintained and treated properly, this is especially true if you plan on conceiving.
Who Is At Risk?
Lupus is more common in women, and symptoms tend to develop between the ages of 14 to 45 or from 60 years of age onwards. It is also common among Asian Americans, Hispanics, and African-Americans.
What Are the Causes?
Since systemic lupus erythematosus happens when your immune system attacks healthy tissue in the body, it likely results from a combination of your genetics and environment. Your environment can include where you live, and the lifestyle you lead (high stress, sleep deprivation etc.)
Is It Safe For You To Get Pregnant?
As a lupus patient, yes, it is safe for you to get pregnant, but you will have to take some extra precautions and steps. Planning is the key to ensuring your pregnancy is safe, healthy, and complication-free. In such cases, a lupus flare is unlikely to happen, but you will need to start planning for the pregnancy well before you get pregnant.
With that said, the majority of lupus patients have a successful pregnancy. As a way to increase your chances of a successful pregnancy, you must seek advice from your doctor about when the right time to conceive would be. Speaking with your doctor would also be a good time to find out more information about how you can further better the outcomes of the pregnancy.
As a lupus patient, your pregnancy is considered to be “high-risk” making it very important that you consult with your rheumatologist and obstetrician. They are both experienced in the process of managing lupus pregnancies and can help you maintain good health when you conceive. They will be able to tell you how to manage a high-risk pregnancy and how you should plan your delivery.
Lupus and pregnancy
A lupus pregnancy can bring about certain complications that other women would not experience. These problems are usually manageable through more frequent visits to your doctors and regular blood tests to ensure that lupus activity is at a minimum, or stays quiet.
Pregnancy and lupus can mean that you might experience flares throughout your first trimester or second trimester. These flares are usually mild, but may still require medicine right away to keep it that way. If left untreated, it can cause premature birth or pregnancy loss. Always consult your doctor immediately if you experience any warning signs of lupus flares such as:
- Chronic fatigue
- Fever
- Hair loss
- Joint pain, swelling of hands or feet, and stiffness
- Malar rash ( butterfly-shaped rash on the cheeks and nose bridge, sometimes elsewhere on the body)
- Shortness of breath
- Chest pain
- Chronic dry eyes
- Persistent headaches
- Confusion and memory loss
Women with lupus also have an increased risk of experiencing other complications. Especially if you are taking a corticosteroid like Prednisone, these complications can include high blood pressure, diabetes, and kidney-related problems. You must regularly visit your doctors to monitor disease activity and maintain a nutritional diet during pregnancy. A healthy lifestyle will help decrease your chances of experiencing unwanted flares and complications.
Why is pregnancy “high-risk” for a mother with lupus
A lupus pregnancy is also high risk because pregnancy complications bring chances of pregnancy loss or risk of miscarriage to occur in about one-fifth of patients. Such incidents most likely happen due to unchecked disease activity. While complications can be severe, as long as you get proper check-ins and tests, severe complications caused by lupus can be prevented altogether. Let’s go through some other factors that may appear during your lupus pregnancy.
Pre Eclampsia
Among the other risk factors on the list for pregnant women with lupus is pre-eclampsia, which is elevated blood pressure, fluid retention, and protein in the urine. If left untreated, it can lead to serious issues and can cause growth problems for your baby. While the exact cause to pre-eclampsia is not known, the problem occurs in the placenta. Symptoms tend to go unnoticed, but since you are more at risk, doctors usually request a BUN blood test to rule this out within your first term.
Lupus Flares
The chances of you experiencing a lupus flare while pregnant significantly decrease if your disease activity has been in remission for five to six months before conceiving. Take note that symptoms of pregnancy can be similar to that of a mild lupus flare, such as joint swelling, skin rashes, and hair loss. A visit to your doctor can easily help you determine which it is and what steps you can take based on the results.
HELLP Syndrome
There is an increased risk of HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets) is the premature degradation of red blood cells. Elevated liver enzymes and low platelets also characterise it. HELLP syndrome occurs in about 10 to 20 per cent of women with severe pre-eclampsia, which is one of the risk factors for women with lupus. Usually, this develops before 37 weeks of pregnancy but it can all develop a week after the baby is born.
Babies born with HELLP Syndrome can have a number of birth injuries, such as Intrauterine growth restriction (IUGR), wherein the baby does not grow as expected in the womb. They also run the risk of severe respiratory distress.
Intrauterine growth restriction
Intrauterine growth restriction is the growth retardation of the fetus in the womb and can have several causes. The most common cause is hypertension and the presence of antiphospholipid antibodies. It could also be due to lupus activity, such as kidney disease.
Antiphospholipid antibodies
The presence of antiphospholipid antibodies leads to antiphospholipid syndrome (APS), which is an autoimmune disorder that leads to increased possibilities of forming blood clots in the vascular structures of the body. Most notably, the placenta is affected in lupus pregnancies during the second trimester. It is best to have a blood urea nitrogen (BUN) blood test done to rule this out. If the placenta is compromised with blood clots, fetal growth, health, and development can be affected. If the results show positive, steps need to mitigate the situation to prevent fetal loss.
Weakened kidney function
A lupus pregnancy may cause weakened kidney function. Lupus kidney disease may occur if you conceive with active lupus. When kidney functions are weakened due to active lupus, excess protein can spill into the urine, which may cause swelling in the ankles, legs, and feet.
Women with high lupus activity should work closely with their doctors when they plan to conceive. Seeking medical advice frequently will mitigate or altogether prevent any of the above complications from occurring during pregnancy. Closely monitor your lupus activity before you become pregnant to ensure a healthy pregnancy.
Planning for pregnancy when you have lupus
Lupus and pregnancy can be something worrying, but most have no complications. Regardless, your pregnancy will still be high-risk to be ready and anticipate any issues that may arise right away. The best time to plan your pregnancy is when lupus activity has been quiet for at least 6 months, meaning that it is in remission. Having active lupus during pregnancy puts you and your baby at a higher risk of pregnancy loss and preterm delivery.
Women with lupus may be required to continue their medication even while pregnant. These medications will prevent flares. Stopping them may increase the chances of further complications that can lead to more serious risks. Speak with your rheumatologists about these medicines.
- Prednisone
- Hydroxychloroquine
- Chloroquine
- Colchicine
- Tacrolimus
- Azathioprine
Your rheumatologists will determine which medicines to continue and at what doses. Usually, hydroxychloroquine can be continued to prevent a flare, and this medication rarely causes any fetal problems. Prednisone will also usually be continued sparingly and at a low dose.
Observing Your Pregnancy
Once you conceive, you will need to start managing your pregnancy by visiting the right doctors. Seek the advice of a perinatologist or maternal-fetal specialist, an obstetrician specialising in high-risk pregnancies and your regular rheumatologist. These two will be your health support system throughout your pregnancy.
You will also need to take the necessary lab tests to ensure there are no further issues. Your doctors will request these tests.
- Urinalysis to check for protein in the urine
- Complete blood count
- Blood chemistry test to determine kidney and liver function
- APS to check for risk of miscarriage
- Anti-Ro and Anti-La antibodies to see if the fetus has a risk of heart block (neonatal lupus). If positive, the doctor will request an echocardiogram starting at 18 weeks.
- Anti-DNA antibodies
- Complement levels
You should visit your rheumatologist at least once every trimester and more often if you experience a lupus flare. If you do, you may need to take Prednisone, which does not cross the placenta unless taken in high doses. Moreover, visit your perinatologist regularly and adhere to their recommendations for rest, exercise, diet, and medications.
During this time, it is very important to pay close attention to your body and what it is telling you. If something does not feel right, do not hesitate to contact your doctor and ask them about it.
Will your baby be healthy after birth?
Regardless of all the possible complications that may occur during your pregnancy, most women with lupus give birth to healthy babies. One thing to note is the possibility of neonatal lupus. Neonatal lupus is not true lupus but rather a rare condition linked with anti-ro and anti-la antibodies from the mother affecting the fetus.
Neonatal lupus means the baby may have a skin rash, liver problems, or low blood cell counts. Still, such symptoms disappear completely after six months with no lasting effects. Congenital heart block is the most severe condition, causing a slow heartbeat and is detected between 18 to 24 weeks old. In this case, your baby may need a pacemaker.
Is Breastfeeding Okay If I Have Lupus?
Your lupus will not affect your ability to breastfeed. But keep in mind that some medications can affect your breastmilk and transfer to your baby. Speak with your doctors about the possibility of lowering your dose of lupus medication while breastfeeding. Generally, medications such as Prednisone and Hydroxychloroquine are okay to take at low doses while breastfeeding with negligible effects.
My pregnancy experience as someone with lupus
As a mother who went through a lupus pregnancy, I can safely say that it is not as scary as it sounds. With the right health advice, consistent visits to the proper doctors and a healthy lifestyle, I had an overall normal pregnancy. I did not experience any severe complications even though my lupus was active during the time I conceived.
During my pregnancy, I stayed on 5mg of Prednisone and Hydroxychloroquine as a maintenance medication to prevent any flares. Luckily, I did not have any during my pregnancy. The only issue I came across was facial oedema, which was attributed more to the pregnancy than to a flare.
My son had a normal delivery and did not have any complications or neonatal lupus. His heartbeat was normal, and all functions were fine. Regardless, he was placed in NICU for a few days to be sure.
All in all, lupus and pregnancy is possible and very manageable so long as you take care of yourself and maintain good monitoring and observation of your body.
