Pregnancy and Lupus
Twenty years ago, medical textbooks said that women with lupus should not get pregnant because of the risks to both the mother and unborn child. Today, most women with lupus can safely become pregnant. With proper medical care you can decrease the risks associated with pregnancy and deliver a normal, healthy baby.
To increase the chances of a happy outcome, however, you must carefully plan your pregnancy. Your disease should be under control or in remission before conception takes place. Getting pregnant when your disease is active could result in a miscarriage, a stillbirth, or serious complications for you. It is extremely important that your pregnancy be monitored by an obstetrician who is experienced in managing high-risk pregnancies and who can work closely with your primary doctor. Delivery should be planned at a hospital that can manage a high-risk patient and provide the specialized care you and your baby will need. Be aware that a vaginal birth may not be possible. Very premature babies, babies showing signs of stress, and babies of mothers who are very ill will probably be delivered by cesarean section.
One problem that can affect a pregnant woman is the development of a lupus flare. In general, flares are not caused by pregnancy. Flares that do develop often occur during the first or second trimester or during the first few months following delivery. Most flares are mild and easily treated with small doses of corticosteroids.
Another complication is pregnancy-induced hypertension. If you develop this serious condition, you will experience a sudden increase in blood pressure, protein in the urine, or both. Pregnancy-induced hypertension is a serious condition that requires immediate treatment, usually including delivery of the infant.
The most important question that pregnant lupus patients ask is, "Will my baby be okay?" In most cases, the answer is yes. Babies born to women with lupus have no greater chance of birth defects or mental retardation than do babies born to women without lupus. As your pregnancy progresses, the doctor will regularly check the baby's heartbeat and growth with sonograms. About 25% of lupus pregnancies end in unexpected miscarriages or stillbirths. Another 25% may result in premature birth of the infant. Although prematurity presents a danger to the baby, most problems can be successfully treated in a hospital that specializes in caring for premature newborns.
About 3% of babies born to mothers with lupus will have neonatal lupus. This lupus consists of a temporary rash and abnormal blood counts. Neonatal lupus usually disappears by the time the infant is 3-6 months old and does not recur. About one-half of babies with neonatal lupus are born with a heart condition. This condition is permanent, but it can be treated with a pacemaker.
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