Lupus and Pregnancy: Tips for Living with Lupus While Pregnant

Lupus does not reduce a woman’s 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.

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.

“Preconception 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,” says Larry Matsumoto, MD, maternal fetal specialist at Atlanta Perinatal Consultants. “Not all women are the same, so it is important to know what your lupus means for your pregnancy.”

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 it’s important to work with your doctor.

• Determine your personal risk for pregnancy complications. Every lupus case is different. Lupus doesn’t 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.

Placental blood clots can endanger your baby’s food and oxygen supply and slow the baby’s growth. If you do have an increased risk of blood clots, your doctor might prescribe a blood thinner such low-dose aspirin, or heparin. You might also be screened for anti-Ro/SSA and anti-La/SSB antibodies. These antibodies pose an increased risk of the baby having a congenital heart block.

Kidney or liver damage caused by lupus increases the chance of complications during pregnancy. Pregnancy tends to increase stress on the damaged organs. “I worry about women with lupus who have kidney disease more than almost any other condition,” says Matsumoto.  “The challenges that pregnancy presents can overwhelm the kidneys and cause irreversible damage.”

• Alter your lupus medicines to protect your pregnancy. Your doctor can help you decide on a lupus treatment plan that’s safe for your baby. Hydroxychloroquine (Plaquenil) and prednisone are considered safe during pregnancy. Methotrexate and cyclophosphamide (Cytoxan) should not be used in pregnancy and should be discontinued for at least a month prior to getting pregnant. Ask your doctor to help you weigh the benefits and risks all your medications.
• Plan your pregnancy. It isn’t always easy to plan a pregnancy. But you should only consider getting pregnant after a thorough health care evaluation. You should also plan to get pregnant during a period of remission or reduced disease activity. You’ll have far fewer complications if your disease isn’t active.

Once you become pregnant:

• See your doctor often. Frequent doctor visits can help identify abnormalities, monitor the baby’s growth, and offer you reassurance. About 25% of lupus pregnancies may result in premature birth of the infant. And between 20% and 30% of women with lupus will experience preeclampsia. This is a sudden increase in blood pressure and protein in the urine, which leads to swelling in body tissue. Preeclampsia often requires urgent treatment and can only be cured by delivery of the baby; therefore seeing your doctor often is of the utmost importance. Your doctor can also monitor your baby’s growth through sonograms or ultrasounds, which are harmless for you and your baby.
• Watch for signs of lupus flares. Recent studies show that lupus flares are rare during pregnancy. In fact, many women experience improvement in their lupus symptoms during pregnancy. If you get pregnant after six months of remission, you’ll be less likely to experience a lupus flare than you would if your lupus were active. Symptoms of a lupus flare can mirror symptoms of pregnancy, so it is important to determine with your doctor whether you are experiencing a lupus flare or just the normal signs of pregnancy. Both can be marked by joint swelling and fluid accumulation, facial rashes, and hair changes. 
• Take it easy to avoid lupus fatigue. Pregnancy can be hard on a woman’s body, and lupus can add challenges to a pregnancy. Getting enough rest is extremely important. Women with lupus should not gain excess unnecessary weight during pregnancy and should follow a well-balanced and healthy diet. Be prepared to modify your activities and routine if you feel tired or are in pain.
• Prepare for the possibility of premature delivery. About 50% of pregnancies in women with lupus deliver prematurely because of complications related to lupus. Choose a hospital that specializes in infant care and offers a neonatal intensive care unit should your baby arrive early or have any health issues. Though prematurity does present risks to the baby, most issues can be properly treated in a hospital that specializes in infant care.