Lupus patients are more likely to develop pregnancy complications compared to the general population. Thus, it is important to consult your rheumatologist and an obstetrician experienced in managing high-risk pregnancies prior to becoming pregnant. Additionally, you should plan your delivery at a hospital that has a Neonatal Intensive Care Unit as well as other advanced facilities to provide the specialized care that you and your baby may require.
Apart from the medical aspects, it is also important that you discuss your pregnancy plans with your partner or close family members. Pregnancy and a newborn often demand changes in your personal and professional life; seeking timely support from family and friends makes it easier to cope with these changes.
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. 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. Although the risk of a lupus flare is not increased in pregnant women when compared to non-pregnant women, lupus flares can occur during pregnancy or immediately following delivery.
Women who conceive at least six months after the lupus disease activity has been brought under control are less likely to experience a lupus flare than those who conceive while their lupus is active. Most patients flaring during pregnancy report fatigue, body aches, fever, butterfly shaped redness across the nose and cheeks, or patchy hair loss. Joint pain and joint swelling are also commonly reported. In case of heart or lung involvement, patients report symptoms such as chest pain or breathing problems.
Nevertheless, if you experience any of the symptoms mentioned above, you should immediately report them to your physician. Lupus flares detected early are easier to treat and in turn cause less harm to the mother and the baby. Lupus patients are at a higher risk for pre-eclampsia increased blood pressure occurring after 20 weeks of pregnancy in a previously normal woman , HELLP syndrome Hemolysis, Elevated Liver Enzymes, Low Platelets , hypertension, renal insufficiency, urinary tract infections, and diabetes.
Diabetes and hypertension occur more commonly in women taking steroids during pregnancy. Blurry vision, headaches, abdominal pain, and decreased frequency of urination could indicate a rise in your blood pressure. Pregnancy loss or miscarriages may occur in approximately one-fifth of lupus pregnancies. Antiphospholipid syndrome APS is an autoimmune disorder caused by aPL attacking vascular structures in the body. As a result, this disorder leads to an increased tendency to form abnormal blood clots in the veins and arteries of the legs, lungs, or placenta.
For this reason, it is important for lupus patients to be screened for aPL especially those women who have experienced a miscarriage previously. Women with a history of miscarriage s and antiphospholipid antibodies are commonly prescribed aspirin and a blood thinner heparin to prevent recurrence.
Finally, lupus patients are at a higher risk for delivering before completing 37 weeks of pregnancy preterm delivery and about one-third of lupus mothers deliver preterm.
Most lupus patients give birth to healthy babies. We have not found any risk factors that predict premature rupture of membranes. In addition to being preterm, the baby is also at risk for intrauterine growth retardation IUGR.
We have not found a clinical variable that is predictive of IUGR. In fact, lupus activity, prednisone, and antiphospholipid antibodies are not predictive of IUGR.
The best predictor using ultrasound monitoring is an abdominal circumference below the 10th percentile and an estimated fetal weight below the 50th percentile. The most important maternal risk, that of a lupus flare, is actually the most controversial. In prospective studies at both Hopkins and in London, the risk of flare is greater in a pregnant than a non-pregnant woman. However, other centers have not confirmed this. There may be differences in patient selection that account for the different findings.
We have found that the hormone prolactin, which rises during pregnancy, is associated with lupus activity during pregnancy. Likely other hormonal influences, especially estrogen, changes in cytokines are involved as well, although these have not been studied. We have found that the type of organ system involvement is different in pregnant vs. In pregnancy we have found an excess of renal and hematologic flares, and fewer arthritis flares. Some of the risk to the mother is not directly due to lupus.
In a case-control study we found that women with lupus were more likely to have multiple complications of pregnancy, including diabetes, urinary tract infections, and pre-eclampsia. For this reason, referral to a high-risk obstetrician is always appropriate. Women on prednisone were more likely to have hypertension and diabetes, as would be expected. The physician caring for a woman with lupus who wishes to become pregnant must review her medications.
You have the best chance of a healthy pregnancy when lupus has been under control for at least six months before conception. Good control of lupus means having normal blood pressure and kidney function, as well as not having a sudden worsening of symptoms, known as a flare.
A flare can include a rash, joint pain, unexplained fever, and fluid around the heart or lungs. Many doctors used to consider pregnancy too dangerous for any woman with lupus, and women were often discouraged from having children because there was a chance that pregnancy could make lupus symptoms worse and increase the risk of complications.
Pregnancy is still considered high-risk for women with lupus, and although this doesn't necessarily mean you'll definitely have problems, you can expect your healthcare provider to monitor you more frequently during pregnancy. You may also be referred to a maternal-fetal medicine specialist , a provider who specializes in high-risk pregnancies.
It's important to know the risks of pregnancy if you have lupus. The most common pregnancy complications for women with lupus are:. In addition to the possible impact of lupus on your pregnancy, there's also a risk that pregnancy could cause your lupus to flare and make symptoms worse. Studies estimating the likelihood of a flare during pregnancy vary widely: They range from about 7 percent for women with good control of their condition to nearly 70 percent for women with very active lupus.
Besides finding out whether you have active lupus, your provider will do tests to determine your individual risk of complications during pregnancy. These tests may include:.
Major organ function tests. Lupus affects all major organs, so your rheumatologist will check on the health of your kidneys, liver, heart, and lungs.
Your kidneys are a particular concern because having lupus nephritis increases the likelihood of developing problems during pregnancy. Pregnancy alone can reduce kidney function, so having lupus compounds the stress on your body. Antibody tests. These tests check for different types of antibodies that cause complications during pregnancy.
For example:. Thyroid function tests. It's common for people with lupus to have thyroid disease as well. Having both thyroid disease and lupus increases the risk of preterm birth. Your provider will ask whether you developed complications during previous pregnancies, and she'll also want to know if you previously developed preeclampsia or HELLP syndrome because the risk of having these again is high.
Also, your provider will review the medications you're currently taking and make sure you're on the safest drugs to control your lupus. It's natural to worry that taking medication could affect your baby, but not taking it could lead to a serious flare, which is bad for both of you.
Recent advances in medical research and care don't necessarily mean it's safe for all women with lupus to get pregnant.
All pregnancies will need careful medical monitoring because of the risk of complications. How lupus affects pregnancy Lupus is a chronic condition that results from a malfunctioning immune system. Complications of pregnancy Most women with lupus are able to have a healthy baby, however sometimes complications can occur. Some of the problems that can occur during pregnancy for women with lupus include: flares of your lupus symptoms may occur during pregnancy or immediately after you deliver, however this is less likely if your condition was stable before you became pregnant high blood pressure hypertension your baby may be born with low birth weight pre-eclampsia — symptoms include high blood pressure and excessive amounts of protein lost through your urine premature labour increased risk of blood clots in the legs or lungs increased risk of miscarriage increased risk of emergency caesarean section increased risk of excessive bleeding after delivery.
Lupus flares and normal pregnancy symptoms Sometimes, it can be difficult to distinguish between a lupus flare and normal pregnancy symptoms. Some of the symptoms of pregnancy that may mimic those of lupus include: fatigue build-up of fluid in the joints skin changes, such as rashes, flushes or darkening hair loss following childbirth shortness of breath joint pain.
Lupus pregnancies and increased rate of premature birth and miscarriage During pregnancy, the growing baby is nourished by the placenta. Lupus and pregnancy delay advice Some women with lupus should delay pregnancy and discuss their plan with their treating doctor when they are planning to have a baby. They include: women whose lupus is active women taking medication such as methotrexate, mycophenolate, or cyclophosphamide women with kidney disease women with previous thrombosis or miscarriage.
Lupus , Musculoskeletal Australia. Planning a pregnancy when you have lupus , Lupus Foundation of America. Antiphospholipid antibody syndrome and pregnancy, Lupus Foundation of America. Pregnancy in women with systemic lupus erythematosus , UpToDate. Give feedback about this page. Was this page helpful?
Yes No. View all immune system. Related information. Lupus Canada - Pregnancy and Lupus factsheet. Lupus Foundation of America.
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