Women with systemic lupus erythematosus (SLE) can often have successful pregnancies and healthy babies. While lupus introduces specific considerations, advancements in medical care mean pregnancy is now a viable option for many. Careful planning and consistent medical oversight are important.
Pre-Conception Planning
Planning for pregnancy well in advance is an important step for women with lupus. It is generally recommended to consult with a healthcare team at least three to six months before attempting conception. This period allows for a thorough assessment of lupus activity and overall health, helping to ensure the best possible start to a pregnancy.
Achieving lupus remission or low disease activity before conception significantly improves pregnancy outcomes. Having the disease under control for at least six months is often advised, particularly if there has been kidney involvement. Active lupus, especially with kidney disease, can increase risks such as miscarriage, stillbirth, and other complications for both the mother and the baby.
A comprehensive review of current medications is important for pre-conception planning. Some lupus medications, such as methotrexate, mycophenolate mofetil, cyclophosphamide, leflunomide, and warfarin, can harm a developing fetus and must be stopped or switched. Healthcare providers can adjust treatment plans to include medications compatible with pregnancy, ensuring continued disease management without posing risks to the baby.
The involvement of a multidisciplinary healthcare team, including a rheumatologist, a high-risk obstetrician, and potentially a neonatologist, is beneficial. This team ensures coordinated care and addresses the unique needs of a lupus pregnancy. Screening for complications, such as antiphospholipid antibodies (aPL), is important, as these can increase the risk of blood clots and pregnancy loss. Assessing kidney function and blood pressure before pregnancy provides a baseline and helps identify pre-existing conditions requiring closer monitoring.
Maternal Health During Pregnancy
Monitoring lupus disease activity throughout pregnancy is important, as flares can occur. Flares are most common in the first or second trimester, though they can happen at any point during pregnancy or after delivery. While many flares are mild, some may require immediate medical intervention to protect both the mother and the baby. Regular follow-up with the healthcare team, typically every one to three months, is necessary to detect and manage changes in disease activity promptly.
Medication management is important during pregnancy, with adjustments made to maintain lupus control while ensuring fetal safety. Some medications generally safe for use include hydroxychloroquine, low-dose corticosteroids, and azathioprine. The healthcare team balances the need to control lupus symptoms with minimizing potential risks to the developing fetus.
Women with lupus face an increased risk of specific pregnancy complications, including preeclampsia, a condition characterized by high blood pressure and organ damage. Preeclampsia rates in lupus pregnancies can range from approximately 7.4% to over 20%. Gestational hypertension and kidney complications, such as lupus nephritis, also require close attention, as these can worsen during pregnancy and affect outcomes. Regular monitoring of blood pressure, urine protein levels, and kidney function helps in early detection and management.
Expectant mothers with lupus should be aware of symptoms indicating a flare or other complications and report them immediately to their healthcare provider. These could include new or worsening joint pain, rashes, fatigue, swelling, or changes in urine output. Early recognition and treatment of these signs can help prevent more severe outcomes. Close collaboration with the healthcare team ensures emerging issues are addressed swiftly, promoting maternal well-being throughout pregnancy.
Fetal and Neonatal Outcomes
Lupus can impact fetal development and increase certain risks for the baby. There is an elevated risk of preterm birth, with rates ranging from 33% to nearly 40% in lupus pregnancies. Babies born to mothers with lupus may also have a higher chance of low birth weight and intrauterine growth restriction (IUGR), where the baby does not grow as expected. IUGR has been observed in approximately 35% of babies in some studies.
A concern is neonatal lupus, a rare, temporary condition that can affect babies born to mothers with certain lupus antibodies, primarily anti-Ro/SSA and anti-La/SSB. While not the same as adult lupus, neonatal lupus can manifest as a skin rash, liver problems, or low blood cell counts. The most serious complication is congenital heart block, a permanent heart rhythm abnormality, which affects less than 3% of babies born to mothers with these antibodies.
Fetal well-being is monitored throughout pregnancy through various methods. Frequent ultrasounds are performed to assess fetal growth and development. Fetal heart monitoring, especially starting around 16 to 18 weeks of gestation for mothers with anti-Ro/La antibodies, helps detect any signs of congenital heart block. This monitoring allows for early detection of potential issues, enabling timely interventions.
Delivery considerations are planned based on the mother’s and baby’s health status. While many women with lupus can have a vaginal delivery, a cesarean section may be recommended if there are complications or if the mother or baby is under stress. The timing and mode of delivery are individualized decisions made by the healthcare team to ensure the safest possible outcome for both.
Postpartum and Long-Term Considerations
The postpartum period carries a risk of lupus flares for the mother. These flares can occur immediately after delivery, and continued monitoring and medication management are important during this time. The healthcare team will continue to assess disease activity and adjust medications as needed to prevent or manage any postpartum flares.
Medication safety during breastfeeding is an important consideration for mothers with lupus. Some lupus medications may pass into breast milk, so it is important to discuss all medications with a doctor to determine which are safe while nursing. Healthcare providers can help devise a treatment plan that supports both the mother’s health and the baby’s safety during breastfeeding.
Follow-up care for the baby is important, particularly if there was a risk of neonatal lupus or other complications during pregnancy. Babies affected by neonatal lupus typically see their symptoms resolve within six to eight months. However, ongoing monitoring for congenital heart block is necessary, as this condition is permanent and requires continued medical attention.
The transition to motherhood with lupus requires ongoing support and self-care. The healthcare team can provide guidance on managing fatigue and other lupus symptoms while caring for a newborn. Seeking support from family, friends, or support groups can also assist new mothers in adapting to these changes and navigating the challenges of both lupus and new parenthood.