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 women who have lupus can have normal pregnancies and healthy babies. However, all women who have lupus and are pregnant are 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 planning to try to get pregnant. Your doctor may want to do blood and urine tests. These tests can help your doctors 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 any problems can be identified and treated early.
Most women who have lupus deliver healthy babies. However, lupus does increase your risk of certain problems during pregnancy, including:
- Elevated blood pressure in pregnancy, which can be gestational hypertension or pre-eclampsia.
- Symptoms include:
- Sudden increase in blood pressure.
- Fluid retention with leg swelling.
- Large amounts of protein in the urine.
- Blood clots. Blood clots can interfere with the supply of oxygen and nutrition the placenta delivers to the baby. Blood clots can also put the mother’s health at risk.
- Early delivery (premature birth).Pregnancy-induced hypertension or blood clots that affect the placenta can increase the risk for premature birth.
- Women who have lupus are at higher risk of miscarrying (about 10%).
If you get pregnant while you are having symptoms of lupus, you are 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. But lupus does seem to appear in certain families. A very small number (about 3%) of babies born to women who have lupus 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 cell 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.
Things to consider
Pregnancy is considered high risk for women who have lupus. Women 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. Women who have lupus and are pregnant are more likely to develop high blood pressure, diabetes and 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 often occur in the first or second trimester and are typically mild. Flares are often easily treated with steroids. The most common signs and symptoms of these flares include arthritis, rashes, and fatigue.
Your doctor will monitor your lupus symptoms and progress during labor and delivery. He or she 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 be feeling after delivering your baby. Some women may experience a flare of symptoms during pregnancy or in the weeks and months after delivery. Put a plan into place just in case you need it. Ask your spouse or partner, other 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?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.