Lupus and Pregnancy
Systemic lupus erythematosus (SLE) can complicate a woman’s pregnancy.
Systemic Lupus Erythematosus (SLE) is more common among women than men. In most cases, the symptoms first appear in women of child-bearing age (usually age 18 to 45).
Pregnancy may mean special problems for women with SLE. Fertility, or the ability to conceive, may be decreased during periods of disease flares. This may be the result of hormonal changes caused by lupus or from side effects of medications used to treat the disease.
During pregnancy or several weeks to months after delivery, women may experience lupus for the first time or may experience a worsening of its symptoms Women with lupus have an increased chance of having a miscarriage. This can occur either early or late in the pregnancy.
Certain abnormal antibodies (including lupus anticoagulant and anticardiolipin antibodies) present in the blood of some women with lupus may contribute to the chance of a miscarriage. Therefore, it is important for a woman with lupus to discuss with her doctor any plan to become pregnant and to be seen regularly during pregnancy. Blood tests to detect the presence of the abnormal antibodies and to measure other signs of lupus activity should be done regularly. With these precautions, many women with lupus can have normal pregnancies.
Occasionally, newborn babies of mothers with lupus have a mild illness caused by transfer of the mother’s antibodies through the placenta to the baby. The illness may include a rash, low blood counts, or an enlarged liver. These features usually go away, generally by six months after birth.
Rarely, babies may have a permanent problem called congenital heart block, which causes a slow heartbeat. This may require treatment with a pacemaker.
Not long ago pregnancy was considered so dangerous for lupus patients that doctors advised the avoidance of pregnancy. Today, with optimal care, most women with lupus can have healthy babies without endangering their own health.
Pregnant SLE patients should be followed in a high-risk pregnancy clinic, and specific blood testing should be performed to assess risks and to guide treatment. Close monitoring is indicated with both laboratory tests and sonograms (ultrasound studies).
Those patients who have had prior first- or second-trimester abortions or those with elevated anticardiolipin levels are often treated with low dose aspirin and heparin to prevent placental thrombosis (clotting). Other patients are given heparin in addition to corticosteroids to suppress the lymphocyte production of anticardiolipin antibodies.
Does pregnancy pose risks to the mother and the baby?
Are there abnormal antibody levels present?
Should further testing and monitoring be done?
Is there a risk of transmitting lupus to the newborn baby?
Will you prescribe any medications?
What are the side effects?
What special precautions should be taken?