Lupus is a chronic autoimmune condition where the body’s immune system mistakenly attacks its own tissues, leading to inflammation across various organs. Since lupus most often affects women during their childbearing years, questions about its impact on reproduction are common. While the condition significantly increases the complexity of pregnancy, lupus itself does not usually prevent a woman from conceiving or carrying a child. Successful pregnancies are possible for most women with lupus, but they require careful planning and specialized medical supervision to manage heightened health risks.
Lupus Effects on Fertility
Lupus disease activity can directly affect a woman’s ability to conceive, often causing temporary subfertility rather than permanent infertility. Active inflammation, or a lupus flare, can disrupt the menstrual cycle and the hormonal environment necessary for ovulation and successful implantation. Lupus nephritis (kidney inflammation) is specifically associated with reduced ovarian function.
The greatest threat to long-term fertility is often linked to the past use of certain treatments for severe lupus. Chemotherapy agents like cyclophosphamide, historically used to manage severe lupus nephritis, can be gonadotoxic. This medication can damage the ovarian reserve, potentially leading to premature ovarian insufficiency or failure, especially when administered in higher cumulative doses.
Modern, low-dose pulsed regimens of cyclophosphamide are less likely to cause permanent harm to the ovaries, but the risk remains for women who received older, aggressive treatment protocols. For patients needing such potent therapy, fertility preservation options like egg or embryo freezing are often discussed before treatment begins. The disease itself does not typically prevent conception, but the severity of the illness and the necessity of certain past treatments are factors that must be evaluated.
Maternal Health Risks During Pregnancy
Once pregnancy is established, lupus introduces several risks to the mother’s health, making the pregnancy high-risk. There is an increased likelihood of a lupus flare, which occurs most frequently during the first or second trimester and in the immediate postpartum period. These flares can affect any organ system but often involve the kidneys or blood cells.
Lupus significantly increases the risk of preeclampsia, characterized by new-onset high blood pressure and protein in the urine after 20 weeks of gestation. The risk is several times higher than the general population, with rates ranging from 13% to 35% in some studies. Distinguishing a severe lupus flare involving the kidneys from preeclampsia can be difficult, requiring careful monitoring and specialized testing to determine the correct treatment.
Pre-existing organ damage, particularly from lupus nephritis, can be worsened by the physiological demands of pregnancy. Many women with lupus also have Antiphospholipid Syndrome (APS), a related autoimmune condition that causes the blood to clot more easily. APS dramatically increases the risk of maternal complications, including deep vein thrombosis and pulmonary embolism, making blood-thinning medication necessary throughout the pregnancy.
Risks to the Developing Fetus and Newborn
Lupus poses risks to the developing fetus, resulting in higher rates of adverse pregnancy outcomes. This includes an elevated risk of miscarriage, especially in the first trimester, and stillbirth later in the pregnancy. Lupus is also associated with fetal growth restriction (FGR), where the baby does not grow at the expected rate, and preterm birth, which occurs in up to 30% of lupus pregnancies.
A specific risk to the newborn is Neonatal Lupus (NL), which occurs when maternal autoantibodies, typically anti-Ro/SSA and anti-La/SSB, cross the placenta. NL often presents as a temporary skin rash or mild, transient blood count abnormalities that disappear within the first few months as the maternal antibodies clear the baby’s system.
The most severe and permanent manifestation of NL is Congenital Heart Block (CHB). CHB occurs in approximately 2% of babies born to mothers who test positive for anti-Ro/SSA antibodies. This permanent damage to the heart’s conduction system often necessitates a pacemaker for the baby, sometimes immediately after birth.
Essential Pre-Pregnancy Planning
Achieving a successful pregnancy with lupus hinges on pre-conception planning and management. Women with lupus should aim for a period of sustained disease inactivity, ideally being in clinical remission for at least six months before attempting to conceive. Conceiving during an active lupus flare significantly increases the risk of complications for both the mother and the baby.
The first step in planning involves assembling a specialized healthcare team, including a rheumatologist and a high-risk obstetrician, often referred to as a perinatologist. This team will review and adjust all current medications. Certain drugs used to treat lupus, such as methotrexate, mycophenolate mofetil, and cyclophosphamide, are known teratogens and must be discontinued well before conception.
These teratogenic medications are typically replaced with pregnancy-compatible alternatives like hydroxychloroquine, which is often continued or started prior to conception. Hydroxychloroquine is safe for the fetus and is associated with a reduced risk of lupus flares and better pregnancy outcomes. Pre-conception screening for anti-Ro/SSA and anti-La/SSB antibodies is also essential to determine the need for specialized fetal cardiac monitoring later in the pregnancy.