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