One question that often arises in women who have been newly diagnosed with systemic lupus erythematosus (SLE) is “Can I safely become pregnant and have a healthy baby?”
The short answer: Yes.
While healthcare professionals in the past may have steered women with lupus away from pregnancy, today the conventional wisdom is that, with proper medical care, risks can be reduced and a woman with SLE can deliver a healthy baby.
But there are risks –- in fact, your pregnancy will be considered high-risk –- and they should be taken into consideration before one becomes pregnant. Anyone planning on becoming pregnant should speak with their healthcare professional and carefully plan their pregnancy.
To help you prepare, here is a short list of questions –- and some general answers with links –- that you can use as reference before talking to your doctor.
What’s the right timing for becoming pregnant?
When your illness, including any kidney disease present, is under control and in remission for at least six months. In other words, when you’re at your healthiest. Getting pregnant when your lupus is active could result in miscarriage or other complications. That said, it’s not uncommon to have a flare during your first or second trimester. These flares, usually not a result of your pregnancy, tend to be mild and easily treated with corticosteroids.
What complications are most common?
One complication that could affect any pregnant woman, but tends to affect pregnant women with lupus more often –- 20%, according to the Lupus Foundation of America -– is preeclampsia. Preeclampsia is the sudden increase in blood pressure, protein in the urine, or both during pregnancy. Lupus or not, it is a serious condition requiring immediate medical attention. It cannot be ignored, since it also places the baby in danger. Also of note, at times, preeclampsia can be difficult to distinguish from lupus nephritis, which affects the kidneys.
Another, specific to women with lupus, is the development of antiphospholipid antibodies, which interfere with the function of the placenta, and can cause blood clots. When they occur in the placenta, they prevent it from growing and working normally.
This condition most often occurs in the second trimester, and can affect fetal growth. But if development is good and pre-pregnancy planning has been developed and followed, the mother’s baby could be delivered and lead a healthy life.
Will my baby be normal?
Your child has no greater risk of birth defect -– mental or physical -– than babies born to mothers without lupus. The only risk your child has that other children do not is developing neonatal lupus. About 10% of women with anti-Ro antibodies –- which amounts to about 3% of all women with lupus — will deliver a baby with neonatal lupus. This is not SLE, but a form of lupus that often disappears during the infant’s first year.
Premature birth is probably the greatest concern. Around half of mothers with lupus deliver before full-term (40 weeks). That said, it is important to note that babies born after 30 weeks, weighing more than three pounds, often do well and grow normally.
To help ensure this is the case, make sure your obstetrician has experience with high-risk pregnancies and that the hospital where you plan to deliver is also experienced in treating high-risk pregnancies.
How will I deliver my baby?
Decisions regarding delivery method -– vaginally or Cesarean section –- are not made well in advance of labor. Situations occurring just before or during labor -– such as premature labor, babies showing signs of stress, mothers who are ill, and so forth -– will determine if a C-section is necessary.
How do I ensure that my pregnancy is a healthy one?
You can take several simple steps, and almost all are steps a mother without lupus should take.
- First, don’t skip any appointments with your doctor. Tracking the progress of your pregnancy and the baby’s growth is vitally important.
- Rest and eat well. Taking care of yourself will promote a healthy pregnancy.
- Take your prescribed medications -– and stop taking any medications your doctor suggests.
- Understand the types of body changes you will undergo, and how your body will react to an increase in hormones and various physical changes. Some can mimic lupus flares, and you’ll want to be able to distinguish between the two.
- Get comfortable calling your doctor. Your obstetrician and his staff will be there for you 24/7. If you’re worried about something -– make the call.
- Take classes. Parenting, childbirth and breastfeeding classes are essential.
- Make sure your finances are in order, you have worked out a return-to-work and childcare plan, and that you have a plan in place for someone to take care of your baby should you become ill.
Caring for your baby
Like every new parent, you will be filled with an array of questions, from how to feed your new son or daughter to how to find time to rest. For new parents with lupus, there are other questions as well, including whether your child will be healthy (there is no reason he shouldn’t be) and if it’s okay to breastfeed.
The opportunity to breastfeed will be determined after a discussion with your doctor, as medicines could pass to the baby through breast milk.
Sources: Lupus: A Patient Care Guide for Nurses and Other Health Professionals, 3rd Edition, Patient Information Sheet #11, Pregnancy and Lupus. National Institute of Arthritis and Musculoskeletal and Skin Diseases.