Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. This condition can affect many different parts of the body, including the skin, joints, kidneys, and blood cells. Symptoms vary widely among individuals, ranging from mild to severe, and often involve periods of illness called flares and periods of remission.
Does Pregnancy Initiate Lupus?
Pregnancy itself does not cause systemic lupus erythematosus. Lupus is a complex condition that develops from a combination of genetic predispositions, environmental factors, and hormonal influences.
However, the significant hormonal changes that occur during pregnancy, particularly fluctuations in estrogen, can act as a trigger for the onset of lupus symptoms in individuals who are already genetically susceptible to the condition. This means that while pregnancy is not a direct cause, it can unmask or accelerate the appearance of symptoms in someone who might have developed lupus later in life, or whose genetic makeup already made them vulnerable.
How Lupus Affects Pregnancy
Having lupus can increase certain risks for the pregnancy itself, regardless of the mother’s disease activity. Women with lupus face a higher likelihood of complications such as miscarriage, occurring in approximately one in five lupus pregnancies. They also have an increased risk of preterm birth, affecting about one-third of pregnancies.
Other potential complications include preeclampsia, a serious condition characterized by high blood pressure and protein in the urine, which occurs in about 20% of lupus pregnancies. Intrauterine growth restriction (IUGR) is another concern. The presence of antiphospholipid antibodies, which increase the tendency for blood clots, can contribute significantly to these adverse outcomes by affecting placental function.
How Pregnancy Affects Lupus Activity
The course of lupus activity in the mother during pregnancy can be unpredictable, with some women experiencing flares while others remain stable or even see improvements. Flares can occur at any point during pregnancy or in the months following delivery. Although the risk of a flare is not increased in pregnant women compared to non-pregnant women, about 30% of women may experience them during pregnancy.
Common symptoms that might worsen or appear during a flare include fatigue, joint pain, and skin rashes. It can sometimes be challenging to distinguish between normal pregnancy symptoms and a lupus flare, emphasizing the need for close medical monitoring. The risk of a significant flare is much higher if lupus was active in the six months prior to conception.
Protecting Mother and Baby During Pregnancy
Careful planning and management are important for women with lupus to have successful pregnancies. Pre-conception counseling is highly recommended to assess risks, optimize disease control, and adjust medications before conception. Ideally, lupus should be in remission or have minimal activity for at least six months before becoming pregnant.
Throughout pregnancy, a multidisciplinary medical team, including a rheumatologist and an obstetrician specializing in high-risk pregnancies, is important for monitoring both maternal lupus activity and fetal well-being. Hydroxychloroquine is generally considered safe and recommended to continue throughout pregnancy to control disease activity and reduce flare risk. Low-dose aspirin may also be prescribed to reduce the risk of preeclampsia. Other medications like prednisone and azathioprine can be used cautiously, while drugs such as methotrexate and mycophenolate mofetil are typically avoided due to potential harm to the baby.
Babies born to mothers with specific antibodies (anti-Ro/SSA and anti-La/SSB) may be at risk for neonatal lupus. Symptoms of neonatal lupus can include a temporary skin rash and liver abnormalities, which usually resolve within 6 to 12 months as maternal antibodies clear from the baby’s system. The most serious, though rare, complication is congenital heart block and can be permanent, sometimes requiring a pacemaker. With close monitoring and appropriate management, most women with lupus can achieve healthy pregnancies and deliver healthy babies.