Doctors once advised women with lupus not to get pregnant due to the potential risks to mother and baby. But while pregnancy with lupus still carries its own set of risks, most women with lupus can safely become pregnant and have healthy babies.
If you have lupus and are thinking about getting pregnant, here's what you need to know about the possible risks and complications. Here's also what you and your doctor can do to help ensure the best outcome for you and your baby.
Preparing for Pregnancy
The first steps toward a healthy pregnancy and baby begin before you become pregnant. If you are considering pregnancy, it's important that you:
Ensure your lupus is under control. The healthier you are when you conceive, the greater your chances of having a healthy pregnancy and baby. Pregnancy places additional stress on kidneys. Having active kidney disease can cause problems in pregnancy and may even lead to pregnancy loss. So if possible, avoid getting pregnant until your lupus has been under control for at least six months. That's especially true for lupus-related kidney disease.
Review medications with your doctor. Some medications are safe to take during pregnancy. Others, though, can harm your baby. Your doctor may need to stop or switch some medications before you become pregnant. Drugs that should not be taken during pregnancy include methotrexate, cyclophosphamide, mycophenolate mofetil, leflunomide, and warfarin. Some drugs need to be stopped months before you try to become pregnant.
Select an obstetrician for high-risk pregnancies. Because lupus may present certain risks -- including pregnancy-induced hypertension and preterm birth -- you will need an obstetrician who has experience with high-risk pregnancies and is at a hospital that specializes in high-risk deliveries. If possible, you should meet with the obstetrician before getting pregnant.
Check your health insurance plan. Inadequate insurance should not keep you from getting the treatment that you and your baby need. Make sure your insurance plan covers your health care needs and those of your baby, as well as any problems that may arise.
Managing Problems of Pregnancy
Regular prenatal exams are important for all women. But they are especially important for women with lupus. That's because many potential problems can be prevented or better treated if addressed early. Here are some problems that can occur during pregnancy that you should be aware of:
Flares. Some women report improvement of lupus symptoms during pregnancy. But flares during pregnancy occur in up to 30% of women. Periods of increased disease activity occur more often during the first few months after delivery. Research suggests that waiting to get pregnant until your disease has been controlled for at least six months reduces your risk of a flare during pregnancy. Most flares, when they do occur, are mild. Your doctor can often treat them with low doses of corticosteroids.
Hypertensive complications. Complications involving high blood pressure can affect up to 20% of pregnant women who have lupus. High blood pressure can be brought on by pregnancy. High blood pressure can also increase your risk of preeclampsia. This is a serious condition in which there is a sudden increase in blood pressure or protein in the urine or both. It occurs in about one out of every five lupus pregnancies. Preeclampsia requires immediate treatment and often delivery of the baby. It is more common in women with kidney disease or high blood pressure and women who smoke.
Miscarriage. Approximately one out of every five lupus pregnancies ends in miscarriage. Miscarriages are more likely in women with high blood pressure, active lupus, and active kidney disease. Miscarriage can also be the result of antiphospholipid antibodies. These are a type of antibody that increases the tendency to form blood clots in the veins and arteries. That includes those in the placenta. For this reason, it is important to screen for the antibodies. It's especially important for women who have miscarried before. If the antibodies are found, your doctor may prescribe a blood thinner. That will help prevent the formation of clots. With the use of such medications, about 80% of the women will not miscarry.
Preterm delivery. About one out of every three women with lupus delivers preterm. That means before completing 37 weeks of pregnancy. This is more likely in women with preeclampsia, antiphospholipid antibodies, and active lupus. It's important to know the symptoms of premature labor, which may include:
- Pelvic pressure
- Leakage of blood or clear fluid from the vagina
- Abdominal cramps
- Contractions occurring every 10 minutes or more
Let your doctor know right away if you experience any of these symptoms.
Women with lupus may have a greater risk of pregnancy complications. They do not, though, have greater chance of having a baby with a birth defect or mental retardation compared to women without lupus.
Caring for Yourself During Pregnancy
In addition to seeing your doctor regularly and following your treatment plan, there are many things you can do to care for yourself and your baby:
Managing Delivery and a New Baby
Your doctor will decide the method of delivery -- cesarean section or vaginal. He'll do this by taking into account your health and your baby's health at the time of labor. Many women with lupus can have vaginal deliveries. But if the mother or baby is under stress, a cesarean section may be the safest and fastest way to deliver. If you have taken steroids during pregnancy, your doctor will increase your dose during labor to help your body cope with the added stress.
While most mothers and babies do well, lupus often flares after the delivery, and other problems, including the following, can occur:
Breastfeeding difficulties. Babies born prematurely may not be strong enough to suckle and draw out breast milk. Mothers who deliver prematurely or are taking certain medications may have trouble producing breast milk. Also, some mothers need to take medications that can pass though the breast milk and are advised not to breastfeed. Most of these issues can be resolved. Speak to your doctor if you have concerns about breastfeeding.
Neonatal lupus. Neonatal lupus is not the same as lupus in the mother. About 3% of babies born to women with lupus will have the condition. Most often it's transient, which means it will pass. The condition consists of a rash and abnormal blood counts. By the time the baby is 6 or 8 months old, the condition usually disappears and never returns. In rare cases, babies with neonatal lupus will have an abnormal heart rhythm that is permanent and may require a pacemaker.
After the delivery, it is important to see your doctor regularly to monitor the changes in your body as it returns to the way it was before you were pregnant. Although you will be focused on caring for your new baby, remember it's important that you take care of yourself.