Lupus (Systemic Lupus Erythematosus or SLE) is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues. While once considered highly risky, medical advancements have made pregnancy possible for many with lupus. However, careful planning and continuous management are necessary for a healthy outcome for both parent and baby.
Planning for Pregnancy with Lupus
Careful planning is crucial for individuals with lupus considering pregnancy. Before conception, consulting a rheumatologist and an obstetrician (ideally a high-risk specialist) is highly recommended to assess health and develop a personalized plan.
Lupus activity level is a primary consideration. Ideally, lupus should be in remission or have very low disease activity for at least six months before conception. Active lupus at conception increases risks for both parent and baby, including flares, preeclampsia, and preterm birth.
Medications require careful review, as some lupus treatments are harmful during pregnancy. For example, mycophenolate mofetil, cyclophosphamide, methotrexate, and leflunomide must be stopped several months before conception under medical supervision.
Assessing for specific lupus-related complications is also important. Kidney disease can significantly impact pregnancy outcomes; individuals with lupus nephritis are typically advised to delay pregnancy until kidney function is stable. Screening for antiphospholipid antibodies (aPL), associated with increased risk of blood clots and pregnancy loss, is also crucial. If present, specific management strategies like low-dose aspirin and heparin may be recommended to improve success.
Potential Risks During Pregnancy
Pregnancy with lupus carries risks for both parent and baby. For the pregnant individual, there is an increased risk of lupus flares during pregnancy or postpartum. Flares are more likely if the disease was active at conception.
Preeclampsia, characterized by high blood pressure and organ damage, is more common in individuals with lupus. This serious complication can lead to kidney problems, blood clotting issues, and seizures if not managed promptly. Lupus nephritis can also worsen during pregnancy. The risk of blood clots also increases, particularly for those with antiphospholipid syndrome.
For the baby, risks include increased miscarriage, especially with active lupus or antiphospholipid antibodies. Preterm birth (delivery before 37 weeks) is also more frequent in lupus pregnancies. Fetal growth restriction (baby not growing as expected) can also occur. A rare but notable condition is neonatal lupus, affecting a small percentage of babies born to individuals with certain antibodies (anti-Ro/SSA or anti-La/SSB). It typically presents as a temporary skin rash or abnormal blood counts that resolve within months, but can rarely cause congenital heart block, a permanent heart rhythm abnormality that might require a pacemaker.
Managing Lupus During Pregnancy
Managing lupus throughout pregnancy requires a collaborative approach from a team of healthcare professionals. A multidisciplinary team, typically including a rheumatologist, a high-risk obstetrician (maternal-fetal medicine specialist), and sometimes a neonatologist, monitors both parent and baby. This coordinated care addresses the unique challenges of lupus in pregnancy.
Medication management is key, focusing on safe and effective treatments during pregnancy. Hydroxychloroquine is generally considered safe and often continued throughout pregnancy, helping prevent lupus flares and improve outcomes. Low-dose aspirin is frequently recommended to reduce the risk of preeclampsia. Some corticosteroids, like prednisone, can be used at the lowest effective dose to manage flares, as they do not cross the placenta significantly. Azathioprine and tacrolimus may be used cautiously when necessary. Individuals should continue prescribed safe medications and not stop them without medical advice, as discontinuing treatment can lead to lupus flares.
Frequent monitoring is essential for both parent and baby. The parent’s blood pressure, urine protein levels, and lupus disease activity markers are regularly checked. For the baby, growth ultrasounds monitor development. If anti-Ro/SSA or anti-La/SSB antibodies are present, serial fetal echocardiograms are conducted (usually starting between 16 and 18 weeks) to detect any signs of congenital heart block. If lupus flares occur during pregnancy, they are managed with medications safe for both parent and fetus, aiming to control disease activity while minimizing risks.
After Delivery
The postpartum period also requires careful attention for individuals with lupus. The postpartum period carries a continued risk of lupus flares, often due to hormonal shifts and physiological changes of childbirth. Regular follow-up appointments with both the rheumatologist and obstetrician are important to monitor disease activity and overall health.
Breastfeeding considerations are also part of postpartum care. Many common lupus medications are compatible with breastfeeding, including hydroxychloroquine, low-dose prednisone, and azathioprine. However, some medications like mycophenolate mofetil, cyclophosphamide, and methotrexate are not safe for breastfeeding and may necessitate alternative feeding methods. Discussion with healthcare providers is crucial to determine safe medication use while breastfeeding, ensuring the well-being of both parent and baby.