Your guide to lupus and pregnancy

Not so long ago, people with lupus were advised not to get pregnant. But thanks to new treatments and a better understanding of the disease, this is no longer true.

Now many people with lupus can have a safe pregnancy and deliver healthy babies.

However, that doesn’t mean the chances of being pregnant while you have lupus are completely gone. Blood clots, decreased kidney function, and premature birth can still occur from pregnancy when you have a diagnosis of lupus.

Close monitoring of your condition by your doctor and changes to your lupus treatment may be necessary to keep you and your baby safe.

In this article, we’ll explain the potential risks of pregnancy if you have lupus, what treatment adjustments may be needed, and how you can best prepare.

Lupus is a chronic autoimmune disease. When lupus is not managed effectively, it attacks healthy tissues in your body, including your organs, blood, and joints.

A lupus flare can affect every system in your body, including your reproductive organs. This is why anyone with lupus who becomes pregnant is considered “high risk.”

But being high risk doesn’t mean everyone with lupus will develop pregnancy complications. And not all pregnancies involving a diagnosis of lupus are in the same risk category.

Lupus is more likely to complicate your pregnancy if you:

  • already have kidney damage (lupus nephritis)
  • have a history of vascular blood clots
  • have irregular blood antibodies
  • recently stopped taking hydroxychloroquine or azathioprine (both are considered safe to take during pregnancy)

People who have well-managed lupus and a plan in place with their doctor before getting pregnant will usually have the best results.

Pregnant women should coordinated care with a maternal-fetal medicine specialist and a rheumatologist in addition to an OB-GYN.

Lupus can put you at greater risk for complications such as:

Less often, more serious complications can occur. These less common complications include:

The stage and severity of your lupus plays a role in your specific risks during pregnancy.

When lupus antibodies affect the function of your kidneys, it is called lupus nephritis. This is one of the most serious possible effects of lupus. People with lupus nephritis are at a higher risk of developing high blood pressure and preeclampsia during pregnancy.

People with lupus can also develop antiphospholipid syndrome (APS), also known as Hughes syndrome. If you have APS and become pregnant, your risk of blood clots during pregnancy is higher.

If you had a kidney transplant as a result of lupus, you can still have a healthy pregnancy and give birth safely.

However, since you received an organ transplant, your risk profile is very different from others. You should speak with your health care team before considering or becoming pregnant.

Some medicines used to treat lupus are not safe to take during pregnancy because they can cause birth irregularities.

If you are hoping or trying to get pregnant soon, it is essential that you speak with your doctor about adjustments to your medications. Switching to another medication before pregnancy can give you time to adjust and reduce your risk of having complications later.

Medications considered unsafe during pregnancy include:

Corticosteroids, such as prednisone, which are often prescribed to treat lupus, may be safe in pregnancy with a doctor’s approval. However, these drugs will be prescribed at their lowest recommended dose during your pregnancy.

antimalarial drugs, of which hydroxychloroquineare considered safe and can generally be continued during pregnancy.

the Centers for Disease Control and Prevention (CDC) recommends avoiding getting pregnant until your lupus is under control or in remission for at least 6 months.

Like other autoimmune diseases, lupus has flare-ups or periods when your symptoms get worse. If you become pregnant while having an active lupus flare, the stress on your kidneys can lead to serious complications.

These include:

  • increased blood pressure
  • blood clots
  • miscarriage

Taking prenatal vitamins and eating a healthy, nutritious diet in the months leading up to your pregnancy can help prevent lupus flare-ups while you’re carrying your baby.

The pregnancy itself is not permanently connected to an increase in lupus flare-ups.

However, changes in your medications as well as additional stress on your body during pregnancy can cause flare-ups while you are carrying your baby.

You may be more likely to have a flare if your disease was particularly active just before conception and in the months following delivery.

It can be confusing and stressful, especially because some of the typical signs of pregnancy can resemble symptoms of a lupus flare-up.

Lupus flare symptoms are usually similar to typical symptoms of the disease, but more severe. You may even experience new symptoms.

These include:

This is where it is essential to be in close communication with your healthcare professionals during pregnancy. They will speak with you to establish a baseline of what the “normal” symptoms will be for you.

If you have an increase in your symptoms during your pregnancy, your doctor may collect and test a urine sample to look for signs of preeclampsia, such as the presence of protein in your urine.

You shouldn’t force yourself to be constantly on high alert, which will cause unnecessary stress. But you should take inventory of your symptoms, writing them down if that helps you keep track.

Preeclampsia and decreased kidney function during pregnancy must be treated immediately for your safety and the health of your baby.

Some people are able to give birth vaginally with lupus. But since your risk of high blood pressure, anemia, and sepsis is higher, your chances of needing a C-section (C-section) are also higher.

Talk to your doctor about your birthing options and create a labor and birth plan in the weeks leading up to your due date.

Most people with lupus are able to breastfeed. But every baby’s feeding journey is different.

If your baby was born prematurely (due to preeclampsia or other complications) and has a low birth weight, you may be advised to supplement breastfeeding with formula.

If you develop high blood pressure during pregnancy, you may need to continue taking blood pressure medication for up to 6 weeks after you give birth.

Before you give birth, you can plan with your doctor how to resume the medications you stopped taking before and during your pregnancy. Some of them are still not safe to take while breastfeeding because they can be passed on to your baby.

You may not be able to resume your old diet immediately.

Pregnancy outcomes for people with lupus are better than ever before. But that doesn’t mean the risks associated with lupus and pregnancy have completely disappeared.

High blood pressure, premature birth, and anemia are some of the possible pregnancy complications if you have lupus.

Certain pre-existing symptoms, including kidney damage and irregular blood antibodies, can increase your chances of a lupus-related pregnancy.

It is important to consult your health care team when planning a pregnancy and to consult specialists. You may need to change your medications, some of which are dangerous for the baby or may increase your risk of serious complications.

It is important to manage your lupus or put it into remission before pregnancy. Together with your doctor, you can create a safe treatment plan for you and your baby to have the healthiest pregnancy possible.

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