Lupus and Pregnancy

Lupus (Systemic Lupus Erythematosus or SLE) is an autoimmune disorder that causes the body’s own immune system to attack itself. Symptoms includelow-grade fevers, joint pain, rash across the cheeks, fatigue, kidney disease, vascular disorders, and altered immune function. Women are most commonly diagnosed during childbearing years, so Lupus and pregnancy is a challenge for sufferers.

Women who suffer from Lupus may rarely have a flare while they are pregnant. There is a good chance for a successful pregnancy if good planning takes place. Read on to learn more about having a baby if you suffer from Lupus.

Lupus and Pregnancy Planning

If you suffer from Lupus and want to have a baby, plan ahead for pregnancy. Talk to your doctor about a plan for a successful pregnancy. It is best to start trying when you are not in a flare and your disease is well-controlled.

If you are coming out of a flare, doctors may advise you to wait six months after the flare has ended. They may also want to make sure your kidneys are functioning well. Lupus causes kidney issues and pregnancy may strain them. This is possibly one reason for miscarriage in mothers who have lupus.

Am I at higher risk for a Lupus flare during pregnancy?

Actually, it has been found that there is no increased risk of lupus flares during pregnancy. While a lupus flare can happen during pregnancy, there are medications to treat the flare that will not harm the baby.

Symptoms of Lupus During Pregnancy

Some of the symptoms of lupus during pregnancy will be the same as prior to pregnancy, but a few may worsen and you may notice some new ones:

  • Joint swelling and pain – this can get worse due to a pregnancy hormone that loosens the ligaments that keep joints in place.
  • Swelling in ankles, hands, and feet – pregnancy causes more fluid retention than normal.
  • Hair loss
  • Extreme fatigue
  • Rash on face – Lupus causes a rash on the face, but pregnancy can make it worse because there is more blood flowing to the skin.
  • Shortness of breath – Weakened lungs from lupus may find it hard to handle the baby pushing up against the diaphragm.

Any of the above symptoms above could signal a flare of lupus during pregnancy. The sooner your doctor treats the flare the better outcome of the pregnancy.

Pregnancy Complications Due to Lupus

There are increased risks for expectant mothers who suffer from lupus. The following are pregnancy complications that are possible:

  • Miscarriage that occurs in 1/5 of expectant mothers with lupus
  • Stillbirth
  • Pre-term birth
  • Fetus small for size
  • Preeclampsia – high blood pressure, increased liver enzymes, kidney deficiencies, and elevated blood sugars

Your doctors will need to watch your health very closely, along with the baby. You may even be referred to an obstetrician who takes care of “high-risk” pregnancies for specialized care.

Will Lupus Hurt My Baby?

Babies born to mothers with lupus have no more incidences of congenital defects than babies born to healthy mothers. If you have a certain antibody called anti-Ro/SSA there is a 25% chance that your baby will be born with neonatal lupus. This is not lasting, but the baby may have some abnormal blood counts and a rash near the eyes for about six to eight months.

There is a slight 3% chance your baby may have congenital heart block. Starting at the 16th week of your pregnancy, the baby will have routine heart checks to make sure there are no symptoms of heart disease. If the doctor is concerned, you may be given steroids to help the baby develop better.

Lastly, your baby may have a little trouble growing. This is known as intrauterine growth retardation and may be born with a lower birth weight. This is often caused by a lupus flare during pregnancy, preeclampsia, or steroid use. Your doctor will do regular ultrasounds to measure the baby’s growth.

How to Treat Lupus During Pregnancy

Unless you are in an active flare, the only medications you will most likely take during your pregnancy is pre-natal vitamins. There are some lupus medications that are not safe in pregnancy. While your regular medications keep lupus flares at bay and it is not good to stop them suddenly, work with your doctor to decide what is best for you and your baby.

Medications that are generally used to control lupus and pregnancy related issues are:

  • Steroids.Your doctor may choose to give you steroid medications. They don’t cross the placenta and affect the baby. Your doctor will most likely give you a very low dose. There are side-effects during pregnancy including high blood sugar, high blood pressure, kidney issues, and lower birth weight in babies born to mothers who took them.
  • Plaquenil®.This is a common maintenance medication to prevent flares and is safe for use during pregnancy. It can help reduce increased kidney issues during pregnancy. It has been found that women who stop using Plaquenil® during pregnancy tend to have more flares.
  • Azathrioprine.This medication is not as safe during pregnancy, but may be used if lupus is severe and cannot be controlled during pregnancy.
  • Heparin.This is a blood thinner that can reduce the risk of blood clots during pregnancy. It needs to be stopped prior to delivery to reduce risk of bleeding.
  • Aspirin.Aspirin may be used in mothers with lupus that have a blood clotting disorder (anti-phosolipid syndrome) to reduce the risk of miscarriage.
  • NSAID’s – If you are on a regular anti-inflammatory regimen, your doctor may allow you to stay on a low dose after you have a positive pregnancy test until you are 28 weeks pregnant. After the 28th week, you would be at increase risk of side-effects like bleeding during delivery.

The following medications may not be taken during pregnancy:

  • Methotrexate
  • Coumadin/Warfarin
  • Cyclophosphamide
  • Leflunomide

Even if a medication is contraindicated during pregnancy, do not stop any medications without consulting your doctor first. Your doctor will work with you to find a safe replacement and prevent flares.

What Can I Do to Take Better Care of Myself If I Am Pregnant with Lupus?

Aside from your regular medication regimen, there are things you can do for yourself that are safe for your baby and will improve how you feel during pregnancy. These include:

  • Lower your stress levels. Stress is a major trigger of lupus flares. Try to reduce stress. Slow down a bit and try to delegate tasks to others.
  • Get regular exercise. Even if it is just taking a daily walk, exercise will help your body and stress.
  • Try some relaxation techniques. Pre-natal yoga, meditation, and breathing exercises will help keep you calm and stress free.
  • Consider cutting work hours. Talk to your boss about cutting back on hours and workload.
  • Eat healthy and low-salt. Eat a healthy balanced diet that is low in salt. Increase your fluid intake, but not more than your doctor recommends if you have kidney issues.
  • Avoid the sun. Use a good sunscreen and avoid the sun if possible. Sunlight triggers lupus flares.

Click here to learn the detailed dos and don’ts during pregnancy.

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