Top Ten Points to Optimize the Outcome
1. Is it possible for lupus patients to have a successful pregnancy?
Many lupus patients can have a successful pregnancy. To increase your chance of a successful pregnancy, it is essential to seek advice regarding the right time to conceive and to educate yourself about ways in which you can optimize the pregnancy outcomes.
Lupus patients are more likely to develop pregnancy complications compared to the general population. Thus, it is important to consult your rheumatologist and an obstetrician experienced in managing high-risk pregnancies prior to becoming pregnant. Additionally, you should plan your delivery at a hospital that has a Neonatal Intensive Care Unit as well as other advanced facilities to provide the specialized care that you and your baby may require.
Apart from the medical aspects, it is also important that you discuss your pregnancy plans with your partner or close family members. Pregnancy and a newborn often demand changes in your personal and professional life; seeking timely support from family and friends makes it easier to cope with these changes.
2. When is it the right time to conceive and what should you do after becoming pregnant?
The right time to conceive is when the lupus disease activity is fully under control and you are in your best health. The healthier you are before your pregnancy, the greater are your chances of having a healthy pregnancy and a healthy baby. It is strongly recommended that you avoid pregnancy until at least six months after the lupus disease activity, especially kidney disease, has been completely brought under control.[1] Pregnancy places an added burden on your kidneys and active kidney disease can even lead to pregnancy loss.
After your pregnancy test is positive, you should visit your rheumatologist and obstetrician at your soonest possible convenience. The purpose of these visits is to assess the state of your health and lupus disease activity by means of a complete physical examination and blood tests.
3. Can pregnancy lead to the worsening of lupus?
Although the risk of a lupus flare is not increased in pregnant women when compared to non-pregnant women, lupus flares can occur during pregnancy or immediately following delivery.[2] Fortunately most of these flares are not life threatening to the mother or the baby and can be treated with steroids.
Women who conceive at least six months after the lupus disease activity has been brought under control are less likely to experience a lupus flare than those who conceive while their lupus is active.[1]
4. How can you identify the symptoms of lupus flare during pregnancy?
Most patients flaring during pregnancy report fatigue, body aches, fever, butterfly shaped redness across the nose and cheeks, or patchy hair loss. Joint pain and joint swelling are also commonly reported. In case of heart or lung involvement, patients report symptoms such as chest pain or breathing problems.
At times, common discomforts of pregnancy can mimic the symptoms of lupus flare. These include:
- Swelling of joints (during pregnancy joint swelling occurs because the ligaments which hold your joints loosen up).
- Joint pain (especially in the lower back).
- Swelling of hands, feet, or ankles (during pregnancy your body tends to retain more fluid).
- Redness over the face, also known as “pregnancy blush” (due to increased blood flow to the skin during pregnancy).
- Loss of hair.
- Fatigue.
- Shortness of breath (this occurs because your diaphragm shifts upwards during pregnancy to make more space for the baby).
Nevertheless, if you experience any of the symptoms mentioned above, you should immediately report them to your physician. Lupus flares detected early are easier to treat and in turn cause less harm to the mother and the baby.
5. What are the complications that can occur in pregnant lupus patients?
Lupus patients are at a higher risk for pre-eclampsia (increased blood pressure occurring after 20 weeks of pregnancy in a previously normal woman), HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets), hypertension, renal insufficiency, urinary tract infections, and diabetes. Diabetes and hypertension occur more commonly in women taking steroids during pregnancy. Blurry vision, headaches, abdominal pain, and decreased frequency of urination could indicate a rise in your blood pressure.
Pregnancy loss (or miscarriages) may occur in approximately one-fifth of lupus pregnancies.[3] They are more likely to occur in women with high blood pressure, active lupus disease, active kidney disease, or antiphospholipid antibodies (aPL).Antiphospholipid syndrome (APS) is an autoimmune disorder caused by aPL attacking vascular structures in the body. As a result, this disorder leads to an increased tendency to form abnormal blood clots in the veins and arteries of the legs, lungs, or placenta. For this reason, it is important for lupus patients to be screened for aPL (especially those women who have experienced a miscarriage previously). Women with a history of miscarriage(s) and antiphospholipid antibodies are commonly prescribed aspirin and a blood thinner (heparin) to prevent recurrence.[2]
Finally, lupus patients are at a higher risk for delivering before completing 37 weeks of pregnancy (preterm delivery) and about one-third of lupus mothers deliver preterm.[5] Preterm deliveries are more likely to occur in patients with pre-eclampsia, aPL, and active disease.[4,5] Lupus patients should be watchful for symptoms of premature labor which include backache, pelvic pressure, blood or clear fluid leaking from the vagina, abdominal cramps, and contractions occurring every 10 minutes before 37 completed weeks of pregnancy.
6. What effects can lupus have on the baby?
Most lupus patients give birth to healthy babies. Babies born to lupus patients have no greater chance of birth defects or mental retardation than those born to women without lupus.
Among lupus patients with anti-Ro/SSA or anti-La/SSB antibodies, the risk that the baby will have neonatal lupus erythematosus is 25%.[6] Neonatal lupus consists of a temporary red, raised rash (usually around the eyes and scalp) and abnormal blood counts; the disease usually disappears by 6 to 8 months of age and does not recur.
Among lupus patients with anti-Ro/SSA or anti-La/SSB antibodies, the risk that the baby will have congenital heart block is less than 3%.[6] Thus, if you carry these antibodies, your obstetrician will regularly check the baby's heartbeat starting at around your 16th week of pregnancy. Depending of the type of heart disease your baby has, your doctor may prescribe steroids to you in order to improve the outcome of your baby.
Babies of lupus patients are also prone to intrauterine growth retardation (IUGR) and low birth weight. This is more likely to occur in pregnancies where the mother is either taking steroids or suffering from pre-eclampsia, hypertension, or active disease. Therefore, it is important to undergo regular ultrasound monitoring to detect IUGR in time and manage it appropriately.
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