Lupus and Pregnancy

Lupus is an autoimmune disease. This means your immune system attacks healthy cells and tissue by mistake. Systemic lupus erythemotosus (SLE) is the most common type. If you have lupus and are pregnant or trying to get pregnant, you may worry about how it will affect you and your baby. Most people who have lupus can have normal pregnancies and healthy babies. However, anyone who has lupus and is pregnant is considered to have a “high risk” pregnancy. It is important to plan ahead and get adequate medical care before, during, and after your pregnancy.

Path to improved health

If you have lupus, the best time to get pregnant is when your disease is under control or in remission (for at least 6 months). Tell your doctor that you are interested in trying to get pregnant. Your doctor may want to do blood and urine tests. These tests can help your doctor know what to watch for during your pregnancy.

Talk to your doctor about any medicines you are taking before you get pregnant. Some medicines used to treat lupus are safe during pregnancy. Some are not. Your doctor may change some of your medicines. Your doctor may also recommend that you take new medicines that can help prevent problems during pregnancy.

After you get pregnant, be sure to get regular prenatal care. Tell your doctor about any lupus symptoms you may have. Your doctor will want to monitor you very closely during pregnancy so that any problems can be identified and treated early.

Most people who have lupus deliver healthy babies. However, lupus can increase your risk of certain problems during pregnancy, including:

• Elevated blood pressure. This could lead to gestational hypertension or pre-eclampsia. Symptoms may include a sudden increase in blood pressure, fluid retention with leg swelling, or large amounts of protein in the urine.
• Blood clots. Blood clots can interfere with the supply of oxygen and nutrition that the placenta delivers to the baby. Blood clots can also put your health at risk.
• Early delivery (premature birth). Pregnancy-induced hypertension or blood clots that affect the placenta can increase the risk for premature birth.
• People who have lupus while pregnant are at higher risk of miscarriage (about 10%).

If you get pregnant while you have symptoms of lupus, you may be at greater risk of having problems. You may need additional monitoring if:

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

Lupus is not hereditary, or passed down in genes. However, lupus does seem to appear in certain families. A very small number (about 3%) of babies born to individuals who have lupus have neonatal lupus. Neonatal lupus is not the same as lupus in adults. It appears to be caused by proteins in your blood that pass to the baby at birth.

Most of the symptoms of neonatal lupus go away during the first few months of a baby’s life. These symptoms may include a rash on the face, head, and chest, liver problems, or abnormal blood cell counts. Rarely, babies who have neonatal lupus may have a heart problem that affects the heartbeat. This problem can be serious, but it is treatable.

Things to consider

Pregnancy is considered high risk for people who have lupus. Individuals who have high blood pressure, lung disease, heart failure, chronic kidney failure, kidney disease, a history of stroke, or a history of preeclampsia may be at higher risk. People who have lupus and are pregnant are more likely to develop high blood pressure, diabetes, or kidney problems, especially if they take corticosteroids during the pregnancy.

Flares (when symptoms get worse, or “flare up”) of lupus are uncommon during pregnancy. They can occur anytime during pregnancy and are typically mild. Flares are often easily treated with steroids. The most common signs and symptoms of flares include arthritis, rashes, and fatigue.

Your doctor will monitor your lupus symptoms and progress during labor and delivery. They may want you to have a cesarean section (C-section) if you or your baby are having any problems that could worsen during the stress of a vaginal birth.

If you are pregnant and have lupus, you should also plan for support after the birth. It’s hard to tell how you might feel after delivering your baby. Some people may experience a flare of symptoms during pregnancy or in the weeks or months after delivery. Put a plan into place just in case you need it. Ask your spouse or partner, family members, and friends for help and support.

Questions to ask your doctor

• Are the medicines I’m taking safe during pregnancy?
• Are there new medicines I should be taking?
• Will my lupus medicines be safe to take while breastfeeding?
• Are there any symptoms that may get worse during or after pregnancy?

Resources

Centers for Disease Control and Prevention: Having a Healthy Pregnancy with Lupus

March of Dimes: Chronic Health Conditions and Pregnancy

U.S. Department of Health & Human Services, Office on Women’s Health: Pregnancy and lupus