Many women who have lupus worry about how it may affect their ability to get pregnant and carry a baby to term. Though pregnancies with lupus are never easy, women with lupus can and do have healthy children. Thanks to early diagnosis, improved prognosis, and changes in attitude, pregnancies with lupus, which were once rare, are now quite common.
What is Lupus?
Lupus is an autoimmune disease affecting one out of every 185 Americans. Ninety percent of those diagnosed with lupus are female, and diagnosis is most often made during childbearing years.
Lupus is a chronic disease that causes inflammation of various parts of the body, especially the skin, joints, blood and kidneys. The immune system, which normally protects the body against viruses, bacteria and other foreign materials, instead turns on the body and produces antibodies that attack the person's own tissues and organs. Lupus can be present in a number of different ways and because of this, it can be hard to diagnose. However, common symptoms are joint and muscle pain, extreme fatigue, persistent low-grade fevers, "butterfly" rash across the bridge of the nose and cheeks, weight loss, hair loss, photosensitivity (sun or light sensitivity), pleurisy (pain in the chest on deep breathing), headaches, and mouth or nose ulcers. Lupus can be mild to life threatening, but most lupus patients can get their lupus under control through education, monitoring, and appropriate therapy.
No one knows what causes lupus, but researchers believe that it may be a combination of factors, including heredity, hormones, immune system dysfunction, infections, or environment.
Lupus and Fertility
Most lupus patients have normal fertility and can conceive a child within a year of trying to become pregnant. However, some of the drugs used to treat lupus (such as cyclophosphamide, brand name Cytoxan) can reduce fertility. High doses of prednisone can stop menstrual periods, but you can still get pregnant when taking the drug.
Lupus and Pregnancy
Lupus may flare during pregnancy, but often times many lupus patients do not have any more trouble with pregnancies than the average woman. In fact, sometimes changes that happen during pregnancy may look like a lupus flare up, but they are actually just a healthy pregnancy symptom and unrelated to lupus. Because of this, lupus flares may be more difficult to detect during pregnancy because of their similarity with pregnancy discomforts. Treatment of flares in lupus during pregnancy is determined by both the mother's and baby's health. There is no need to treat a pregnant woman with lupus to prevent a flare. Instead, flares are dealt with if and when they occur.
Of course, it is best not to take any sort of drug while pregnant, but a woman's lupus should not go untreated if she is pregnant. In fact, a lupus flare may be worse for the baby than a drug to treat it. Aspirin and prednisone are both considered safe during pregnancy, while there is debate as to the safety of other drugs. Cyclophosphamide (Cytoxan) should not be used due to the danger of fetal malformations and miscarriages.
There are two types of required monitoring for pregnant lupus patients: monitoring the mom and the baby. At the beginning of the pregnancy, all standard lupus tests are conducted, and antiphospholipid antibody, anti-Ro/SSA, and anti-La/SSB antibody levels are determined to ensure that the mother is healthy. Throughout the pregnancy there is also frequent monitoring of urine and blood for signs of lupus, especially red blood cell count, platelet count and urine protein.
The fetus is checked using ultrasound tests and its growth is monitored. At about twenty-five weeks (six months), a series of tests for the baby's general health begin. None of these tests are invasive, painful, or dangerous to the mother or baby. Depending on the situation, they might be done one time only, or they might be done weekly or daily.
Lupus and Baby
There are no specific genetic risks for babies born to mothers with lupus, nor is there worry of slower intellectual development than the average child. There is however, a risk of miscarriage and premature birth, but careful monitoring can lower the risks.
Approximately one third of babies born to women with lupus contract neonatal lupus, but this is not serious and it consists mostly of a rash brought on by sun exposure that will go away on its own.
A rare manifestation of neonatal lupus, called heart block is more serious and causes a slower than normal heartbeat in the unborn baby. However, this cannot be treated before birth, and the baby's general health is closely monitored throughout the pregnancy. After birth the baby may need a pacemaker. Heart block will occur in less than one percent of babies born to mothers with lupus.