Lupus does not reduce the odds of becoming pregnant—however, lupus pregnancies are considered high risk and must be planned and monitored carefully. “Forty years ago, women with lupus were advised not to become pregnant,” says Maternal Fetal Medicine Specialist Dr. Kecia Gaither. “But we know a lot more about the disease now and its effects on the body such that a successful pregnancy is possible for most women with lupus.”

Systemic Lupus Erythematosus, or “Lupus” is a chronic autoimmune disease that can affect many parts of the body. It occurs when the body's immune system malfunctions, attacking its own tissues and organs, often causing inflammation, pain and dysfunction throughout the body. Lupus affects everyone differently. Some people experience flares – periods when symptoms show up – followed by periods when symptoms fade and the disease is in remission. Some may have frequent flares; others may go years in which the disease is in a quiet state. “Women are at more risk of developing lupus than men,” says Dr. Gaither. “It occurs ten times more often in women and most often strikes women of child-bearing age, between 15 and 44. That makes issues of pregnancy and childbirth particularly pertinent. It's important that a woman with lupus plan her pregnancy with her medical team.”

Planning for Pregnancy
It is important for a woman with lupus to meet with her doctor several months before trying to become pregnant. The doctor will do a complete evaluation of the state of the disease, may recommend modifying medications to reduce the risk of flares and to protect the fetus, and will probably recommend seeing a high-risk obstetrician. “The best time to become pregnant is when lupus is in remission or during a period of reduced disease activity, preferably when it has been under control for six months or more,” says Dr. Gaither. “Each woman's situation is different and a complete exam, including blood tests, will help assess her individual risk of complications.”

Being Pregnant
Regular doctor visits are important for all pregnant women but even more vital for women with lupus. Along with the usual checks of maternal health and fetal development, tests will evaluate the mother's kidney and liver function, and check for the presence of antibodies that might signal a risk of miscarriage or fetal heart problems. “Pregnancy puts stress on the body,” says Dr. Gaither, “and women with lupus face additional challenges. They must start with the basics: get enough rest to avoid fatigue; avoid excessive weight gain, smoking and alcohol; and eat a well-balanced diet made up of nutritious foods. Women whose lupus has been in remission for six months are less likely to suffer a flare during pregnancy than those whose disease is active. Some symptoms of a flare – such as joint pain and fluid accumulation – are similar to those of pregnancy, so the doctor's help is needed to determine the cause of these symptoms.

Complications

• Miscarriage: Lupus does not increase the risk of first-trimester miscarriage but about one-third of women with lupus have antibodies that increase the risk of developing blood clots that can cause stillbirth or miscarriage later in the pregnancy. Blood tests screen for these antibodies and treatment with anti-coagulants can reduce the risk.
• Preterm birth: Women with lupus have a higher risk of delivering before 37 weeks, usually due to preeclampsia – a hypertensive disorder of pregnancy – Preterm birth is more likely in women with active lupus and high blood pressure.
• Growth restriction: women with Lupus have an increased risk of having growth restricted babies—particularly if renal involvement is present. It’s important during the course of pregnancy, that frequent assessments of fetal growth be made.
• Neonatal lupus: About 3% of the babies born to women with lupus have this condition, characterized by skin rash, liver problems, or low blood cell counts. It is not the same as adult lupus and is usually, transient, disappearing after about six months with no lasting effects.

Dr. Gaither concludes: “It isn't always easy to plan for a pregnancy but the first steps toward a healthy pregnancy and baby for a woman with lupus begin before she is pregnant. Most women whose disease is under control do not suffer flares during pregnancy and with sensible self-care and medical monitoring, they have successful pregnancies and deliver healthy babies.”

Kecia Gaither, MD, MPH, FACOG, a perinatal consultant and women’s health expert, is a double board-certified physician in OB/GYN and Maternal-Fetal Medicine in New York City. Dr. Gaither is Director of Perinatal Services at Lincoln Medical and Mental Health Center, a member of NYC Health + Hospitals System in Bronx, New York. http://www.keciagaither.com