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Is pregnancy too risky if I have lupus?

If you have a type of lupus called systemic lupus erythematosus (SLE) and you are thinking about getting pregnant, you may worry about how it will affect you and your baby. Most women who have SLE can have normal pregnancies and healthy babies. However, it is important to plan ahead and get adequate medical care. Contact your healthcare provider about what you can do to prepare for your pregnancy.

What types of problems can SLE cause during pregnancy?

SLE increases your risk of certain problems during pregnancy, including:

• Pregnancy-induced hypertension(PIH), also called toxemia or preeclampsia (say “pre-ee-clamp-see-ah”). Symptoms of PIH include sudden increase in blood pressure, fluid retention with leg swelling, and large amounts of protein in the urine.
• Blood clots that can affect the placenta. Blood clots can interfere with the supply of oxygen and nutrition the placenta delivers to the baby.
• Early delivery (premature birth). Pregnancy-induced hypertension or blood clots that affect the placenta can cause premature birth.

Will I have a higher risk of miscarrying?

Women who have lupus are at higher risk of miscarrying (about 20-25%) or delivering early up to about 50%)  However, most women who have SLE deliver healthy babies.

Will pregnancy make my lupus worse?

Some women who have SLE notice that their symptoms get worse (called a “flare”) during or after pregnancy. However, some normal discomforts of pregnancy may seem like a flare. This is one of the reasons staying in touch with your healthcare provider is so important during pregnancy. Your healthcare provider can tell you what symptoms are normal for pregnancy and identify others that may relate to SLE to treat them right away.

What could put me at greater risk for problems during pregnancy?

If you have SLE and get pregnant while you are having symptoms, you are at greater risk of having problems. Any of the following can increase your risk and require additional monitoring:

• Your kidneys, heart or lungs are affected by SLE.
• You have high blood pressure.
• You had problems during a previous pregnancy.
• You have certain proteins in your blood that could cause complications.

How can I plan for pregnancy?

Plan to try to become pregnant after you have been feeling healthy, and your symptoms of SLE are under control or not present (in remission) for at least 6 months. Tell your healthcare provider that you are planning to try to get pregnant. Your healthcare provider may want to do some tests, such as blood and urine tests. These tests can help your healthcare providers know what to watch for during your pregnancy. After you get pregnant, be sure to get good prenatal care. Go to your prenatal visits as scheduled by your healthcare provider. This is especially important for women who have SLE. Also, tell your healthcare provider about any symptoms you may have. Your healthcare provider may want to monitor you very closely during pregnancy so any problems can be identified and treated early.

Will I need to stop taking my medicines when I get pregnant?

Before you plan to get pregnant, contact your healthcare provider about your medicines. Some medicines used to treat SLE are safe during pregnancy, but some are not. Your healthcare provider may change some of your medicines. Your healthcare provider may also recommend that you take medicines that can help prevent problems during pregnancy.

Will I have to have a cesarean section?

This depends on how you are doing at the time of labor and delivery. Your healthcare provider may want you to have a caesarean section (C-section) if you or your baby are having any problems that could worsen during the stress of a vaginal birth.

Will I be able to breastfeed my baby?

Several things can determine if you will be able to breastfeed. If your baby is premature, they may not be strong enough to suckle (latch onto the breast and take milk). In this case, you may be able to use a breast pump to collect milk for feeding. If your baby is born earlier than expected, your breasts may not be quite ready to produce milk. Some medicines can interfere with producing milk, or can be passed through breast milk and be harmful to the baby. Many medicines are safe though, especially if taken at low doses. Be sure to talk to your healthcare provider about your medicines and how they may affect breastfeeding.

Will my baby be healthy?

Babies born to mothers who have SLE are not at higher risk of birth defects or mental disabilities.

Will my baby have SLE?

Probably not. A very small number (about 3%) of babies born to women who have SLE have neonatal lupus. Neonatal lupus is not the same as lupus in adults. It appears to be caused by proteins in the mother’s blood that pass to the baby at birth. Most of the symptoms of neonatal lupus go away during the first few months after birth. These symptoms may include a rash on the face, head and chest, and problems with the liver and with blood counts. Rarely, babies who have neonatal lupus also may have a heart problem that affects the heartbeat. This problem can be serious, but it is treatable.

Will I be able to care for my newborn baby?

If you have SLE and are planning to get pregnant, also plan for support after the birth. It’s hard to tell how you might be feeling after giving birth. Some women who have SLE do just fine while others may experience a flare of symptoms either during pregnancy or in the weeks and months after delivery. Put a plan into place just in case you need it. Call on your spouse or partner, other family members and friends for help and support.

Checklist for Lupus and Pregnancy

• Contact your healthcare provider before you try to get pregnant. They can help guide you regarding the timing of your pregnancy, your symptoms and your treatment.
• Plan to get pregnant when your symptoms are not present or have been under control for at least 6 months.
• Some medicines are safe during pregnancy, while others are not. Be sure to contact your healthcare provider about possible medicine changes. Don’t stop taking your medicines without talking to your healthcare provider.
• Your healthcare provider may want you to have blood and urine tests before you become pregnant. These tests can show if you have proteins in your blood that could require extra monitoring of you and your baby during pregnancy.
• If you have any symptoms—old or new—during pregnancy, be sure to let your healthcare provider know right away.
• If you do not wish to get pregnant, contact your healthcare provider about birth control methods that would be a good fit for you.

FOR MORE INFORMATION

Lupus Canada
https://www.lupuscanada.org/