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Lupus & Pregnancy
Just a few years ago women with lupus
were told not to get pregnant and if they happened to become pregnant
they were encouraged to abort. Thankfully, that is not the case any
longer. The majority of women with lupus who become pregnant go on to
deliver a normal, healthy baby. That isn't to say that there aren't
serious risks associated with lupus and pregnancy. You must carefully
evaluate the risks and decide if pregnancy is right for you.
There are some instances in which you should not even consider a
pregnancy. For example, no woman who is taking cyclophosphamide should
become pregnant, effective birth control is a must. Women taking
warfarin should also be discouraged from becoming pregnant. There are
also other medications which must be stopped before attempting to
conceive. Obviously you need to discuss this with your rheumatologist
and gynecologist.
Most lupus pregnancies are considered high risk. You can avoid some
major problems with frequent check ups. Many of the problems that can
occur are easily treatable if caught in the early stages. Around 20% of
women with lupus will become toxemic during pregnancy. This causes high
blood pressure, swelling, headaches and in some cases, seizures. This
condition requires immediate medical care and in some cases immediate
delivery to prevent permanent damage to both mother and child. The fetus
must also be monitored with frequent ultrasounds and heart monitoring.
Again, some problems can become serious when allowed to go unchecked,
early treatment of any problem results in a healthier baby.
Another maternal health risk is a lupus flare. Some studies have shown
that pregnancy can increase the possibility of a flare while other
studies dispute this. If a flare occurs, medication options are limited
due to the pregnancy which makes controlling the flare problematic.
Another concern is the presence of antiphospholipid antibodies, the
lupus anticoagulant or anti-cardiolipin antibodies. One-third to
one-half of women with lupus have these antibodies, which can be
detected by blood tests. These antibodies cause blood clots that can
occur in the placenta which cause problems in the developing fetus.
These antibodies are also associated with a higher rate of miscarriage
than in the general population.
Premature delivery is common among women with lupus. According to one
study as many as 50% of all lupus pregnancies end prematurely. But at
least one study showed these infants to be healthier than a premature
infant of a "normal" mother, one reason may be that these
babies deal with more intrauterine stress than other infants so they are
stronger.
Many women with lupus fear that their children will develop lupus at
some point in their life. This fear is usually unfounded. Lupus rarely
occurs in children whose mothers had lupus. There is something called
Neonatal Lupus which is different from SLE. About 33 percent of lupus
patients have an antibody known as anti-Ro or anti-SSA antibody.
Approximately 10% of these women will deliver an infant who has Neonatal
Lupus. This causes a rash, blood count abnormalities and in some cases a
problematic heartbeat. The heart problem is treatable, but permanent.
Despite all the possible problems 50% of all lupus pregnancies are
totally normal, 25% percent deliver premature but normal babies. Sadly,
the other 25% result in fetal loss, either due to miscarriages or death
of the premature infant. Frequent medical check ups are essential to a
healthy mother and child.
The decision to become pregnant can only be made by you, your partner
and your healthcare team. Even then, it is ultimately up to you.
Resources:
PREGNANCY AND LUPUS, Michael D. Lockshin, M.D., Lupus Foundation Of
America
Hopkins Lupus Pregnancy Center: 1987 to 1996, Rheumatic Diseases Clinics
of North America, Volume 23, Number 1, February 1997
Copyright ? 1997 W. B. Saunders Company
Handout On
Health: Lupus, NIAMS
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