Systemic lupus erythematosus (SLE, or lupus), can affect pregnancy. Most women with this autoimmune disease are able to have children. However, pregnancies in women with lupus need careful medical monitoring because of the risk of complications.
It is generally best to have no lupus symptoms and to have taken no medication for at least six months prior to conception.
How lupus affects pregnancy
Lupus is an autoimmune disease that tends to appear in women of childbearing age. The woman develops antibodies against her own cells, resulting in inflamed tissues in her body. Any part of the body can be affected, including joints, skin and internal organs. Depending on the areas affected, and the severity of the symptoms, lupus can be mild or life-threatening.
It is vital that you consult your doctor and medical specialist if you have lupus and intend to become pregnant. They may need to make important changes to your medication to ensure a safe pregnancy. The best way to have a safe pregnancy is to have lupus well controlled at the time of conception, so it is in your best interest to work with your healthcare team.
In some cases, there is a reduction in lupus symptoms during pregnancy. A woman’s lupus is more likely to be stable throughout her pregnancy if the disease was stable before conceiving.
Some of the problems a pregnant woman with lupus may face include:
- pre-eclampsia – with symptoms including hypertension (high blood pressure) and excessive amounts of protein excreted in the urine
- premature labour
- birth defects – which may be caused by some medications for lupus
- your baby being born with low birth weight
- a worsening of symptoms (flare) during pregnancy or straight after childbirth. This is more likely if the disease was active prior to you becoming pregnant.
- hospital admission may be needed at various stages throughout your pregnancy.
Medical care for lupus before and during pregnancy
If you have lupus, it is important to have adequate medical care before and
during your pregnancy. Ideally, you will be able to discuss becoming pregnant with your treating specialist before you conceive.
They can advise you of the best time to fall pregnant – it is advisable to have had no lupus symptoms for at least six months prior to conception. They can also discuss with you the particular risks you may face and whether your medication needs to be changed. Some medication taken for lupus can cross the placenta and pose a threat to your baby.
Once pregnant, it is important to contact your treating doctor in case your treatment needs to be changed or further tests are required. Proper antenatal care is vital in order to anticipate, prevent and solve any problems that may occur.
It is also important to closely monitor the growth rate of the baby to make sure that all is well. It is recommended that you consult closely with both a rheumatologist and a specialist obstetrician throughout your pregnancy.
Lupus flares and normal pregnancy symptoms
Sometimes, it can be difficult to distinguish between a lupus flare and normal pregnancy symptoms. It is important to consult closely with your healthcare providers and obstetrician.
Some of the symptoms of pregnancy that may mimic those of lupus include:
- build-up of fluid in the joints
- skin rashes or flushes
- hair loss following childbirth.
Lupus pregnancies and increased rate of miscarriage and premature birth
During pregnancy, the growing baby is nourished by the placenta. About one third of women with lupus have antiphospholipid antibodies (lupus anticoagulant or anti-cardiolipin antibody) that may cause blood clots and interfere with the proper functioning of the placenta.
This is most likely to happen in the second trimester. The impaired placenta is not able to supply the baby with sufficient nourishment and the baby’s growth is slowed. This may require early delivery via caesarean section. If the baby is born after 30 weeks’ gestation, or is at least 1.3 kg in weight, its chances of survival are good.
Pre-eclampsia is a condition that involves increased blood pressure or protein in the blood (or both). It occurs in one in five women with lupus. If left untreated, this condition endangers the life of both the woman and baby. Pre-eclampsia can be treated. However, depending on the severity, it may also require early delivery.
Around one third of women with lupus have anti-Ro or anti-SSA antibodies. These antibodies may cause lupus-like symptoms in the baby once it is born. This is known as neonatal lupus. Symptoms may include skin rash, unusual blood count and, rarely, heartbeat irregularities. This is not SLE.
In those babies who don’t experience heartbeat irregularities, all symptoms of neonatal lupus usually resolve by three to six months of age. Heartbeat irregularities can be successfully treated.
Pregnancy delay advice
Some women with lupus should delay pregnancy if they are planning to have a baby. They include:
- women whose lupus is active
- women taking medication such as cyclophosphamide, chlorambucil, hydroxychloroquine (Plaquenil) and azathioprine
- women with kidney damage (nephrotic syndrome).
Where to get help
- Your doctor
- A specialist (often a dermatologist, rheumatologist, nephrologist or immunologist)
- Arthritis Victoria Tel. (03) 8531 8000 or 1800 011 041
Things to remember
- Lupus (or SLE) is an autoimmune disease that involves inflammation of various tissues in the body.
- Lupus tends to appear in women of childbearing age.
- The majority of women with lupus are able to have children.
- If you have lupus, it is best to consult with your doctor before planning a pregnancy.
- If you have lupus, it is best to consult with both a rheumatologist and a specialist obstetrician throughout your pregnancy.
This page has been produced in consultation with and approved by:
Arthritis Victoria incorporating Osteoporosis Victoria
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