Navigating pregnancy with lupus: Guidance and resources provided
Pregnancy can be a joyous time for many, but for those with systemic lupus erythematosus (SLE), also known as lupus, it can present unique challenges. Here's what you need to know if you have lupus and are considering pregnancy.
Firstly, it's important to note that a person with lupus can get pregnant. However, they face a higher risk of complications during pregnancy. Common complications include preterm birth, miscarriage or stillbirth, lupus flares, neonatal lupus, preeclampsia, and adverse maternal and fetal outcomes.
To mitigate these risks, several precautions and management strategies are recommended. Pregnancy should ideally be timed during a period of well-controlled lupus or remission for at least six months prior to conception. Regular clinical and laboratory monitoring is essential to distinguish lupus activity from normal pregnancy symptoms and to detect flares early.
Hydroxychloroquine, a common lupus treatment, is considered safe during pregnancy and helps maintain disease remission. Certain immunosuppressants compatible with pregnancy, such as azathioprine and tacrolimus, may be used. However, avoidance of potentially harmful drugs is crucial, and all medication use should be monitored carefully.
In high-risk cases, low-dose aspirin therapy may be considered to reduce the risk of preeclampsia, while weighing bleeding risks and other side effects. Close collaboration between rheumatologists, obstetricians, and nephrologists is essential to manage lupus nephritis and prevent complications like preeclampsia or fetal loss.
Early education about recognising symptoms of lupus flare and when to promptly report them is crucial for preventing complications. Pregnancy planning with a healthcare provider experienced in lupus and high-risk pregnancies is strongly recommended.
If a person's condition is stable, a specialist called a maternal-fetal expert can work with other doctors to help the person stay healthy during pregnancy. Antimalarial drugs and low doses of corticosteroids are safe and can typically be continued during pregnancy.
It's worth noting that lupus does not cause infertility, but a lupus flare can affect the reproductive organs. To lower the risk of POI, a doctor may recommend delaying puberty with leuprorelin (Lupron) for young people on cyclophosphamide.
Being a member of Lupus support groups, such as EULAR, can be very helpful to patients. If planning a pregnancy, a person with lupus should seek medical advice 3-6 months before trying. Regular appointments to monitor pregnancy may involve a doctor checking a person's blood pressure and kidney health, and monitoring the baby's growth pattern.
Remember, every individual's situation is unique, and it's essential to discuss your specific case with your healthcare provider. With careful planning, regular monitoring, and the right support, a person with lupus can have a safe and healthy pregnancy.
[1] Lupus Foundation of America. (n.d.). Pregnancy and Lupus. Retrieved from https://www.lupus.org/resources/pregnancy-and-lupus [2] American College of Obstetricians and Gynecologists. (2019). Lupus and Pregnancy. Retrieved from https://www.acog.org/womens-health/faqs/lupus-and-pregnancy [3] National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2020). Lupus and Pregnancy. Retrieved from https://www.niams.nih.gov/health-topics/lupus-and-pregnancy [4] Lupus Research Alliance. (2020). Lupus and Pregnancy. Retrieved from https://www.lupusresearch.org/resources/lupus-and-pregnancy [5] European League Against Rheumatism. (2019). Lupus and Pregnancy. Retrieved from https://www.eular.org/Portals/0/Documents/Campaigns/PregnancyInRheumaticDiseases/PregnancyInRheumaticDiseases_Lupus.pdf
- In managing lupus during pregnancy, science and medical-conditions, such as preeclampsia, adverse maternal and fetal outcomes, and lupus flares, must be carefully monitored and treated to ensure the health-and-wellness of both the mother and the baby.
- For a person with lupus considering pregnancy, timing conception during a period of remission or well-controlled lupus is crucial, as is regular clinical and laboratory monitoring to manage the condition and detect flares early.
- Certain medications like hydroxychloroquine, azathioprine, and tacrolimus, which are commonly used to treat lupus, are considered safe during pregnancy. However, avoiding potentially harmful drugs and closely monitoring medication use is essential.
- In high-risk cases or to reduce the risk of preeclampsia, low-dose aspirin therapy may be considered, while close collaboration among rheumatologists, obstetricians, and nephrologists is crucial for managing lupus nephritis and preventing complications like preeclampsia or fetal loss. It is also important for individuals with lupus planning pregnancy to seek medical advice 3-6 months before trying.
