Lupus and Pregnancy

Then and Now

As little as 20 years ago a woman with systemic lupus was advised by her physician not to become pregnant because of the risks to both mother and baby, especially the risk of miscarriage if there was a flare of the disease. Today many women with lupus conceive, carry and birth normal, healthy babies. With proper medical care and proper self-care, risks can be reduced to those attendant any normal pregnancy and birth.

What is Lupus and How Does it Affect the Body?

Lupus is an autoimmune disease, which basically means that a body's defense system attacks itself rather than viruses and bacteria that invade the body. When this self-attack occurs, inflammation is caused, which in turn causes swelling, pain, and tissue damage throughout the body. In cases where lupus is severe, problems with the kidneys, heart, lungs, nervous system or blood cells can occur. Although we use the name lupus when we refer to this disease, it is called systemic lupus erythematosus and is also known by its acronym, SLE.

It's a complex disease and lupus can affect many different parts of the body, including:

· Joints

· Skin

· Internal organs

Symptoms of Lupus

The symptoms are varied and may include any or several of the following:

· Skin rash

· Arthritis

· Fever

· Anemia

· Fatigue

· Hair loss

· Mouth sores

· Kidney problems

What Causes Lupus?

The cause of lupus is not known but experts are of the mind that some people are born with specific genes that affect the function of the immune system. These are the people who are more prone to lupus than others born without this particular gene. The disease is lifelong and can become serious when it gets severe. However, most people with the disease are able to control the symptoms and prevent organ damage. Diet, exercise, adequate rest and medications all work synergistically to keep lupus in check.

How Does Lupus Affect Pregnancy?

Although a lupus pregnancy is still considered to be high risk, with careful planning before pregnancy and a commitment to work alongside the doctor throughout the pregnancy, needs can be evaluated and the pregnancy can go along smoothly.

Timing, as they say, is everything. The best time for a woman with lupus to become pregnant is when her disease is under control, and that includes any kidney disease or other problems that are related to the lupus. The disease and related illnesses should be in remission at least six months before becoming pregnant. That translates into being at the healthiest place ever. When pregnancy occurs during an active phase of lupus, miscarriage or other complications can occur. However, that said, it is common for a woman to have a flare during the first or second trimester, but it tends to be mild and easily treated with corticosteroids.

One of the most common complications associated with pregnancy and lupus is preeclampsia - the sudden increase in blood pressure, protein in the urine, or both during pregnancy. It is a serious condition and medical attention is required immediately. If ignored, the baby's life is endangered. Another potential risk that is specific to pregnant women with lupus is antiphospholipid antibodies, which affect the function of the placenta. Blood clots can prevent the placenta from functioning and growing normally.

Will the Baby be Okay?

Of course, the most important question to a pregnancy woman with lupus is, "Will my baby be alright?" The answer to that question, overall, is yes. The baby is at no greater risk for birth defects, whether mental or physical, than babies born to mothers who do not have lupus. The biggest risk the baby has that other babies don't have is the possibility of developing neonatal lupus. This is not SLE, but a form of lupus that can appear as a rash which usually is gone by the time the baby is a year old.  There are other potential health issues for the baby born with neonatal lupus, including issues concerning the heart.

Premature birth is the other consideration and probably the one with the greatest concern attached to it. Although about 50% of mothers with lupus deliver before full-term, a baby that is born past 30 weeks gestation and weighing more than three pounds often does quite well.


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