Lupus and pregnancy

Lupus tends to appear in women of childbearing age. It can affect pregnancy, but most women with lupus are able to have children. Because there is a risk of complications, all pregnancies need careful medical monitoring. It is generally best to wait six months after a flare and, ideally, to have no active lupus symptoms before conceiving.

How lupus affects pregnancy#

Lupus is a chronic condition caused by a malfunctioning immune system. The immune system is meant to identify foreign bodies, such as bacteria and viruses, and attack them to keep us healthy. In lupus, the immune system mistakenly attacks the body’s own tissues, such as the skin, joints, muscles, nerves, kidneys, heart or lungs. The result is ongoing inflammation and pain.

For these reasons, it is important to plan your pregnancy carefully. The healthier you are before you become pregnant, the greater the chance of a healthy pregnancy and a healthy baby. Aim to have your condition under control and to be in the best possible health before conceiving.

Medical care before and during pregnancy#

Talk with your doctor and specialist before you get pregnant. They may need to make important changes to your medication to keep your pregnancy safe. Some medicines are safe in pregnancy, but others, such as methotrexate, should not be taken. You may need to stop certain medicines months before trying to conceive, because they can harm your baby. Your doctors will help you plan this.

For some women, lupus symptoms ease during pregnancy. Your lupus is more likely to stay stable throughout pregnancy if it was stable before you conceived. Most women with lupus go on to have a healthy baby, but complications can sometimes occur. That is why it is so important to work closely with your healthcare team to be as healthy as possible before, during and after pregnancy, and to know the possible problems so they can be treated early. Many of these problems can be prevented or treated effectively when dealt with promptly.

Discuss your plans with your doctor and specialist before you conceive. They can advise you on the best time to try for a baby (ideally after at least six months with no lupus symptoms), explain any particular risks you may face, and let you know whether your medication needs to change, as some lupus medicines can cross the placenta and pose a threat to the baby.

Once you are pregnant, proper antenatal care is vital to anticipate, prevent and manage any problems. Stay in contact with your treating doctor in case your treatment needs to change or further tests are required. It also helps to work closely with both a rheumatologist and a specialist obstetrician throughout pregnancy, to lower the risk of complications and monitor your baby’s growth.

Complications of pregnancy#

Some of the problems that can occur during pregnancy for women with lupus include:

• flares of lupus symptoms during pregnancy or just after delivery (less likely if your condition was stable beforehand)
• pre-eclampsia, with symptoms such as high blood pressure and large amounts of protein lost in the urine
• high blood pressure (hypertension)
• a baby born with low birth weight
• premature labour
• increased risk of blood clots in the legs or lungs
• increased risk of miscarriage
• increased risk of excessive bleeding after delivery
• increased risk of an emergency caesarean section

Telling a lupus flare from normal pregnancy symptoms#

Sometimes it can be difficult to tell a lupus flare apart from normal pregnancy symptoms, which is another reason to work closely with your healthcare team and obstetrician. Pregnancy symptoms that may mimic lupus include:

• joint pain
• fatigue
• build-up of fluid in the joints
• skin changes, such as rashes, flushes or darkening
• hair loss after childbirth
• shortness of breath

Effects on the placenta and the baby#

During pregnancy, the growing baby is nourished by the placenta. About one third of women with lupus have antibodies that can cause blood clots and interfere with how the placenta works. This is most likely to happen in the second trimester. When the placenta cannot supply enough nourishment, the baby’s growth slows, and this may require early delivery by caesarean section. If the baby is born after 30 weeks’ gestation, or weighs at least 1.3 kg, its chances of survival are good. Your doctor can screen for antiphospholipid antibodies and, if they are found, may prescribe a blood thinner to help prevent clots. This can help prevent miscarriage in many women.

Pre-eclampsia involves raised blood pressure, fluid retention and protein in the urine. It occurs in about one in five women with lupus and, if left untreated, can endanger the lives of both mother and baby. Pre-eclampsia can be treated, but depending on its severity it may require early delivery.

Neonatal lupus#

Around one third of women with lupus have antibodies that can cause lupus-like symptoms in their baby after birth. This is known as neonatal lupus, and it is not SLE. Symptoms may include a skin rash, an unusual blood count and, rarely, heartbeat irregularities. In babies who do not have heartbeat irregularities, the symptoms of neonatal lupus usually resolve by 3 to 6 months of age. Heartbeat irregularities can be successfully treated.

When to delay pregnancy#

Some women with lupus should delay pregnancy and discuss their plans with their treating doctor. They include:

• women whose lupus is active
• women with previous thrombosis or miscarriage
• women taking medicines such as methotrexate, mycophenolate or cyclophosphamide
• women with kidney disease

If you have any questions about your condition, your medications or pregnancy, talk with your doctor.

Key points#

• All pregnancies in women with lupus need careful medical monitoring because of the risk of complications.
• It is important to plan your pregnancy carefully and be in the best possible health beforehand.
• Your medication may need to be changed to keep the pregnancy safe.
• In some cases, lupus symptoms ease during pregnancy.
• Know the possible problems in advance so they can be treated promptly.

Where to get help#