A woman with Systemic Lupus Erythematosus (SLE) can get pregnant, but it is considered a high-risk pregnancy that demands comprehensive planning. Lupus is a chronic autoimmune condition where the immune system mistakenly attacks healthy tissues, which can complicate gestation. Successful outcomes require meticulous preparation and management by a specialized medical team. Preparation involves careful timing and a thorough review of all medications to ensure the safety of both the mother and the developing fetus.
Timing Pregnancy During Disease Remission
Achieving a stable, inactive state of the disease is the most significant factor for a successful lupus pregnancy. Physicians advise waiting until SLE is in complete remission, ideally for a minimum of six months, before attempting conception. This stability is necessary because active lupus at conception is linked to a substantially increased risk of adverse outcomes.
Conceiving during active disease increases the chance of a maternal lupus flare, which can have severe consequences. Active disease also raises the probability of complications such as preeclampsia and fetal loss. Pre-conception counseling with a rheumatologist confirms sustained remission and optimizes health. This planning allows time to stabilize on pregnancy-compatible therapies, setting the stage for a healthier gestational period.
Reviewing Medications for Safety
Managing lupus treatments requires a specialized approach to balance disease control with fetal safety. Some medications are teratogenic, meaning they can cause birth defects, and must be discontinued well before conception. For instance, immunosuppressive drugs like mycophenolate mofetil and cyclophosphamide are strictly contraindicated and require switching to an alternative therapy months in advance.
Conversely, certain lupus treatments are safe and necessary to continue throughout the pregnancy. Hydroxychloroquine is highly recommended for all women with lupus during gestation, as it helps prevent flares and is associated with improved outcomes, including a lower risk of preeclampsia. Other therapies generally considered safe maintenance options include azathioprine, low-dose corticosteroids, and calcineurin inhibitors like tacrolimus. Low-dose aspirin is often initiated early, particularly for those with risk factors, to help reduce the maternal risk of preeclampsia.
Potential Complications for Mother and Infant
Lupus introduces specific risks during pregnancy that require intensive monitoring.
Maternal Risks
Maternal complications frequently center on the kidneys and the vascular system. Lupus nephritis, inflammation of the kidneys caused by lupus, significantly raises the risk of poor outcomes, especially if the disease is active at conception.
The most recognized severe maternal complication is preeclampsia, characterized by high blood pressure and signs of organ damage, typically occurring after 20 weeks. Women with lupus, particularly those with a history of lupus nephritis, have a risk of developing preeclampsia several times higher than the general population. Distinguishing a preeclampsia flare from a lupus nephritis flare is challenging, as both present with similar symptoms like high blood pressure and protein in the urine, necessitating specialized diagnostic testing.
Fetal and Neonatal Risks
Risks to the infant primarily involve growth and timing of delivery. Preterm birth (delivery before 37 weeks) occurs more frequently in lupus pregnancies. There is also an increased incidence of intrauterine growth restriction (IUGR) and a higher risk of fetal loss.
A passively acquired condition is neonatal lupus, caused by the mother’s autoantibodies crossing the placenta. This condition is linked to the presence of anti-Ro/SSA and anti-La/SSB antibodies. The most serious manifestation is congenital complete heart block, an irreversible slowing of the fetal heart rate, occurring in about one to two percent of exposed fetuses.
Neonatal lupus can also cause a temporary skin rash and blood count abnormalities in the newborn, which usually resolve within six months as the maternal antibodies clear. If a mother has previously had a child with congenital heart block, the recurrence risk rises to approximately 17 to 18 percent. Weekly fetal heart monitoring is performed starting around 16 weeks for mothers who test positive for these autoantibodies.
Essential Members of the Care Team
A collaborative, multidisciplinary approach is necessary to manage a lupus pregnancy successfully. The care team must be coordinated to address the unique intersection of a chronic autoimmune disorder with gestation.
The Rheumatologist is central, managing lupus disease activity, adjusting medications, and monitoring for flares throughout the pregnancy.
The Obstetrician, specifically a Maternal-Fetal Medicine (MFM) specialist, manages the pregnancy itself. MFM specialists are high-risk pregnancy experts who provide specialized monitoring, including frequent ultrasounds and testing, to detect and manage complications like IUGR, preeclampsia, and fetal distress. Additional specialists, such as a Nephrologist or a Pediatric Cardiologist, may also be integrated depending on the woman’s specific health profile.