Systemic lupus erythematosus (lupus) is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. This inflammatory response can affect various body systems, including the joints, skin, kidneys, blood cells, brain, heart, and lungs. While lupus presents unique considerations, successful pregnancies are frequently possible for individuals with this condition, requiring careful planning and ongoing medical management.
Considering Conception with Lupus
Individuals with lupus considering pregnancy should prioritize careful planning, ideally initiating discussions with their healthcare team at least six months before attempting conception. Achieving a stable period of disease inactivity, ideally six months of remission, is important to reduce potential risks for both parent and baby. This planning involves assessment by a multidisciplinary medical team, including a rheumatologist and an obstetrician specializing in high-risk pregnancies.
Medication review and adjustment are necessary, as some lupus treatments are unsafe during pregnancy due to risks of birth defects or complications. Medications such as mycophenolate mofetil, methotrexate, and cyclophosphamide are generally avoided, while hydroxychloroquine, low-dose aspirin, and certain corticosteroids like prednisone are often considered safe and continued throughout pregnancy. While lupus itself does not directly cause infertility, some associated conditions or medications can affect fertility, making a discussion about these potential challenges with a specialist helpful.
Navigating Pregnancy with Lupus
Pregnancy with lupus requires increased medical monitoring to manage the condition and ensure the well-being of both parent and fetus. Regular doctor visits, often monthly or more frequently if disease activity warrants, are necessary. These visits include tests to track lupus activity and organ function, such as complete blood counts, kidney and liver function tests, urinalysis, and checks for anti-double-stranded DNA antibodies and complement levels.
Lupus flares, periods of increased disease activity, can occur during pregnancy, particularly in the first or second trimester or in the initial months after delivery. Proactive management, often with pregnancy-compatible medications like corticosteroids, can help mitigate risks. Differentiating lupus symptoms from normal pregnancy changes, such as fatigue or swelling, is also part of this careful monitoring.
Potential Impact on the Baby
Lupus can influence fetal development and may increase certain risks for the baby, including preterm birth and low birth weight. These risks are higher if lupus is active at conception, if kidney disease is present, or if there is high blood pressure before pregnancy. Fetal monitoring is important, often involving frequent ultrasounds to assess growth and placental function.
Neonatal lupus, a rare condition, can affect babies born to individuals with specific antibodies, such as anti-Ro/SSA and anti-La/SSB. This condition can manifest as a temporary skin rash, blood count abnormalities, or, in serious cases, congenital heart block. Skin and blood issues typically resolve within six months without lasting effects; however, congenital heart block is permanent and may necessitate a pacemaker. Fetal echocardiography is recommended between 16 and 26 weeks of gestation to monitor for this heart condition, particularly if these antibodies are present.
Life After Delivery
The postpartum period carries an increased risk of lupus flares, particularly in the weeks and months after childbirth. Continued medical monitoring by the multidisciplinary team is important to detect and manage any flare-ups.
Discussions about breastfeeding while on lupus medications should occur with healthcare providers, as some medications can enter breast milk, though many are compatible. Future family planning and contraception options are important considerations for individuals with lupus after delivery.