Lupus and pregnancy

In part 1 of our lupus blog series, we provided a basic understanding of what lupus is, and how it is diagnosed and treated. In part 2, we focused on the various types of lupus. As we continue our lupus blog series, this article will focus on how women with lupus can prepare for a safe pregnancy and have healthy babies.

Lupus is a condition that affects the quality of life of roughly five million people across the globe. Out of these five million, the majority of sufferers are non-Caucasian women (particularly those of Asian or African descent), who are of childbearing age (between ages 15 and 44 approximately). Because women are the majority of those affected, many of them may wonder whether lupus can potentially be passed down from mother to child, and what steps can be taken to ensure a safe pregnancy.

Of the different types of lupus outlined here in part 2 of our lupus blog series, one in particular concerns the topic at hand. Neonatal lupus occurs due to the problematic immune system of a pregnant woman (who already has lupus) targeting the fetus during pregnancy.

Before going into the major risks associated with lupus and pregnancy, it should be noted that pregnancy is not made less likely by the condition.

However, this is with the exception of sufferers who have previously been treated with a drug known as cyclophosphamide. This is a potent medication that can reduce fertility rates in both men and women, and which must not be taken by pregnant or breastfeeding women. It is recommended that lupus-afflicted individuals go at least three months off this medication prior to conceiving, and that they use contraception in the meantime.

This medication aside, women with lupus should ensure that before any attempts to conceive, they already know all the risks and probabilities that they may encounter if they become pregnant. If a woman affected by lupus is already pregnant, it is strongly recommended that she seek medical counsel as soon as possible. Cyclophosphamide is far from the only danger present when it comes to becoming pregnant; there are a number of other issues to take into account.

Among the more serious pregnancy complications that may arise are:

• Antibodies targeting the fetus: The mother’s antibodies targeting the fetus – the same antibodies that target her own tissues and organs. These antibodies can also cause blood clots (leading to babies born with congenital heart block in some cases) and lowered oxygen supply to the fetus’s brain.
• Preeclampsia: Lupus can also increase the risk of preeclampsia (high blood pressure and organ damage in the mother).
• Premature birth: In some cases, premature birth can happen due to various pregnancy complications caused by the lupus disease.
• Symptom flare-ups: Because of the nature of the disease (which often alternates between dormant and active), pregnancy means that around 60% of women experience strong flare-ups of their symptoms while expecting.
• Miscarriage and fetal loss: Miscarriage is not made more likely in the first term, but chances of it may increase later on in the pregnancy. The odds of this are slightly more elevated in the cases of women who also have a condition known as antiphospholid syndrome. Fetal loss may also occur after the first 10 weeks – the risk of this is present not just for women with lupus, but also women with high blood pressure and other medical conditions. It is best to consult with a doctor about each individual’s situation.

The presence of all of these threats is why women with lupus are strongly advised to seek medical counsel if planning on becoming pregnant, or if already pregnant.

Preconception counseling is a medical screening that is performed on lupus-affected women prior to becoming pregnant. This is an assessment that runs tests for various potential threats to the health of the fetus, such as the risk of blood clots, the degree of kidney and/or liver damage (if any), the risk posed by certain antibodies in the mother’s immune system, and others. Doctors will also conduct blood tests to check for the presence of rubella and hepatitis.

Aside from those, all prescription drugs currently being taken will need to be reassessed in the context of a pregnancy – some of these medications may be changed, whereas some may be halted altogether. Drugs such as hydroxychloroquine, or plaquenil (an antirheumatic) and prednisone (a corticosteroid, or anti-inflammatory drug) are considered safe to use. On the other hand, drugs such as Cytoxan and the aforementioned cyclophosphamide should not be used during and/or prior to conception. Each patient’s doctor will provide a full list of suitable and unsuitable medications upon completed medical assessment.

General lifestyle changes are also necessary, such as quitting smoking, avoiding alcohol and recreational drug use, as well as limiting caffeine consumption. Women whose lupus symptoms are still active will be asked to wait for a six-month-long remission prior to attempts to conceive – this will lower her chances of flare-ups during pregnancy.

With all of these concerns in mind, it is very important – and urgent, in the case of lupus-affected women who are already pregnant – for women to consult a doctor if they wish to conceive. Preconception counseling can screen for numerous risks posed to the health of both the fetus and the mother. The most immediate changes to make are those of lifestyle and habit, such as smoking and drug use, as well as the requirement that women wait for at least half a year’s remission, to ensure a stable pregnancy.

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