Pregnancy and lupus

Lupus is a type of autoimmune disease. Such diseases cause the immune system to attack the body. Lupus can result in widespread damage to your joints, tendons, and organs. It most often affects the heart, lungs, kidneys, and brain.

Symptoms of lupus may be mild to severe. They also often come and go. These flares can cause fever, rashes, inflammation of the joints, hair loss, and mouth ulcers. The disease can also lead to more serious symptoms. These include kidney disease, nerve problems, and weight loss.

Pregnancy may or may not increase the symptoms of, or change the course of, lupus. Flares may occur at any time in pregnancy or after you have the baby. But they are usually mild. During a flare, your body is more vulnerable to damage from the disease. Lupus can also make other health problems more likely to happen during pregnancy.

Complications from lupus

Lupus can affect pregnancy at any stage. But flares most often occur in the first trimester. Pregnant women with lupus, especially those having a flare, are at higher risk for complications. These include:

• Miscarriage

• Preterm delivery, especially with a lupus flare

• Early breaking of the amniotic sac (premature rupture of membranes)

• High blood pressure during pregnancy (preeclampsia)

• Poor growth of the baby (intrauterine growth restriction)

• Stillbirth

• Infection

• Low platelets

• Transfusion

• Blood clot formation

• Unplanned cesarean section

Pregnancy loss may be linked to how severe your lupus was when your baby was conceived. Or it might happen if lupus begins during pregnancy. Women with high levels of antiphospholipid antibodies may be at higher risk, too. These antibodies cause abnormal blood clotting. Researchers also think that kidney disease with lupus may play a role in miscarriage.

A rare, temporary condition called neonatal lupus may affect babies of mothers with lupus. This condition can cause a congenital heart block. That’s when the heart beats slower than normal. Neonatal lupus can also cause blood abnormalities and skin rashes on a baby’s face, scalp, chest, and upper back. All of these symptoms often go away in the first year. A child with neonatal lupus is not often at risk for lupus as an adult.

Steps to a healthy pregnancy

If you are planning on becoming pregnant, it’s best to see your healthcare provider 3 to 6 months beforehand. Women who have had no flares in the 6 months before conception tend to have the best chance of a good pregnancy outcome. Having your lupus under control can help prevent many health problems.

Because you may have a higher risk for pregnancy loss with lupus, you may need more frequent prenatal visits. Your medicines may also need to be changed. Some lupus medicines, such as methotrexate, may cause birth defects or other problems during pregnancy. Talk with your healthcare provider for the best guidance. Also tell your healthcare provider if you have a history of the following:

• High blood pressure

• Kidney disease

• Blood clots

• Preeclampsia

• High levels of antiphospholipid antibodies

During your pregnancy, you may need tests to make sure everything is OK. Blood and urine tests can watch for specific antibodies that help track the severity of lupus. They can also watch the condition of your liver and kidneys. You may also need tests that check on your baby's health.

Here are some additional steps you can take to help make sure of a healthy pregnancy:

• See your healthcare provider regularly, at least once every trimester. You may need more frequent visits if you have a flare.

• Follow your healthcare provider’s directions about diet and exercise.

• Take your medicines as directed.

• Stay away from alcohol, tobacco, and drugs.