Lupus
What is Lupus?
Lupus is a chronic and complex autoimmune disease with a variety of symptoms caused by inflammation in one or more parts of the body (e.g., skin, muscles, joints, blood, blood vessels, heart, kidneys, brain).
The immune system normally protects the body against viruses, bacteria and other harmful substances, however with lupus, the immune system begins to attack the body's own cells. This can cause inflammation that may affect the joints, skin, brain, lungs, kidneys, and blood vessels, causing widespread inflammation and tissue damage in the affected organ.
Among people ages 15 to 45, women are eight times more likely than men to get lupus, however Black women are three times more likely to have lupus.
If you plan on getting pregnant what should you know?
Lupus does not usually affect your ability to get pregnant. However, if you are having a lupus flare or are taking corticosteroids, you may have irregular menstrual cycles that can make it difficult to plan your pregnancy.
If you become pregnant, it is likely your pregnancy will be considered high risk because of a higher risk of lupus flare during pregnancy. However, careful planning can help you carry your baby safely and healthily to term. Most women with lupus have healthy pregnancies and carry their baby safely to term.
If you have lupus and another condition such as high blood pressure, stroke, lung disease, heart failure, chronic kidney failure, kidney disease, or a history of preeclampsia, pregnancy may be very risky. In this case, it is important to consult with your healthcare provider as soon as possible before becoming pregnant, and to work with an obstetrician who manages high-risk pregnancies.
Before becoming pregnant, it is important to make sure your lupus is stable, minimally active, or in remission for six months before conceiving. Consult with your healthcare provider before becoming pregnant to make sure your medications are safe for pregnancy. Your healthcare provider may do tests to have a baseline that your lupus during pregnancy can be compared.
Your preconception assessment will include testing for anti-Ro antibody. Anti-Ro antibody is associated with heart rhythm disturbances in babies of mothers with the antibody, and approximately 25% of women with lupus have anti-Ro antibody.
If you are pregnant with lupus, you will be able to breastfeed. Some medicines might pass through your breastmilk to your baby, you can discuss with your healthcare provider the safety of your medications during breastfeeding and make a plan for breastfeeding. Some possible difficulties you may face include:
- Preterm babies may have trouble with latching and sucking. You may feed by tube and bottle at first and pump breastmilk for your baby.
- Corticosteroids may reduce the amount of milk you can produce.
These difficulties can be addressed by speaking to your healthcare provider who may refer you to a lactation consultant.
To ensure a safe and healthy pregnancy for you and your baby, it is important to see your healthcare provider as soon as possible and be monitored by a multidisciplinary team.
If you are pregnant and have lupus, you should contact your health care provider as early as possible to help manage your lupus.
What Are the Risks for Pregnancy?
If your lupus is active when you conceive or you have a severe flare during pregnancy, you're more likely to have complications. However, the risk drops dramatically if you wait to conceive when your disease has been in remission for at least six months.
You may have mild flares during pregnancy, usually in the first or second trimester. Some flares may be more serious and require medication immediately or cause you to deliver early. If you are experiencing warning signs of a flare, you should contact your healthcare provider immediately.
Some women with lupus have protein in their urine and high blood pressure. This serious condition is known as preeclampsia and requires immediate treatment that may include delivering the baby early. While pregnant, you may be at higher risk for preeclampsia, approximately 2 in 10 pregnant women with lupus develop preeclampsia. The risk is higher in women with lupus who also have a history of kidney disease. Black women are also at higher risk of preeclampsia. Signs and symptoms of preeclampsia include sudden weight gain, swelling in your hands and face, blurred vision, dizziness, and stomach pain. Preeclampsia can cause you to deliver your baby early.
Pregnancy may increase your risk of high blood pressure, gestational diabetes, and kidney problems. However, these risks can be reduced and prevented through good nutrition and regular visits with your healthcare provider to monitor these risks early on.
Babies born to mothers with lupus are healthy most of the time. However, rarely, infants can be born with neonatal lupus which is caused by certain antibodies in mothers. At birth, infants with neonatal lupus may have skin rashes, liver problems, and/or low blood cell levels. They may also develop a serious heart defect called congenital heart block. For most babies, neonatal lupus goes away after several months and does not return. Your doctor will test for neonatal lupus during pregnancy and will begin treatment either before or soon after birth.
Pregnancy with lupus
It's important to distinguish between symptoms of a lupus flare and normal body changes that occur during pregnancy. Aching joints are common during pregnancy. Although the joint pain could suggest inflammation due to lupus, it may simply be a normal side effect of pregnancy. Flares can occur in any trimester. They can range from mild to severe with the most common symptoms being arthritis, rashes and fatigue. Lupus rashes may appear to get worse during pregnancy, but this is usually because there's more blood flowing to the skin in pregnancy.
How Should I Care for Myself While I’m Pregnant?
Taking good care of yourself during pregnancy can help prevent flares and boost your odds of having a healthy baby. Here is what you can do:
- Get plenty of rest
- Protect yourself from the sun by wearing protective clothing and sunblock, since ultraviolet light can trigger a flare
- Keep all your prenatal appointments to monitor lupus related symptoms
- Eat a well-balanced diet by including fruits, vegetables and whole grains as part of a healthy diet, you may be advised to avoid salt
- Do not smoke because smoking raises your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels
- Talk to your health care provider before you get pregnant to manage your condition, keep you safe before, during and after pregnancy
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