Yes, many lupus patients have successful pregnancies however
lupus may sometimes affect fertility and lupus pregnancies can
sometimes end in miscarriage or stillbirth. This leaflet is a
generalised guide to "lupus and pregnancy" and it is important
that you discuss any plans with your doctor before you become
pregnant, so that your care can be individualised.
What should I do if I want to become pregnant?
Lupus is a disease that can potentially affect many different
organs in the body and the disease can affect people in different
ways. Its course may be influenced by the state of pregnancy
and a pregnancy can be influenced by lupus.
As with all pregnancies, it is generally advisable to make sure
that you are as fit as possible before pregnancy. It is also
sensible to stop taking tobacco and alcohol and to take folic
acid supplements before getting pregnant. It is advisable to
consult your doctor about how stable your lupus is, as it is best
to wait at least six months after a flare before becoming
pregnant. This is because it has been found that the pregnancy
is more likely to be successful when your disease is well
controlled and stable. If your lupus is newly diagnosed it is also
advisable to wait for the disease to become stable before
becoming pregnant for the same reason.
Before you become pregnant it is important that all the
medications that you are taking are reviewed by your doctor.
Medications may sometimes have an effect upon your ability to
conceive, the development of the unborn baby or your own
health. Your lupus specialist will be able to make sure that you
are on the best combination of drugs and that they are suitable
Common medications that may be used in pregnancy include:
• Prednisolone • Ranitidine
• Hydroxychloroquine • Paracetamol
• Azathioprine • Calcium and Vitamin D
• Nifedipine • Folic Acid
When should I seek additional advice
If you are planning pregnancy it is advisable to receive additional
advice from a doctor who specialises in lupus and pregnancy.
It may be necessary to perform further tests and investigations
so that you can be given the best advice about the possible
risks to you and your baby.
It is particularly recommended that you should receive such
counselling if your lupus has been very active recently or has affected
your kidneys, brain or heart and lungs in the past. It is often necessary
to perform further investigations and advise you accordingly about
possible problems for you and your baby during pregnancy.
It is also recommended that ladies with anti-phospholipid
syndrome receive such counselling so that they may be started
on the correct treatment as soon as they become pregnant.
What should I do if I become pregnant?
As soon as you become pregnant you should call your doctor
in case additional changes need to be made to your treatment.
Referral to the appropriate antenatal clinic can then be made.
Women who suffer with lupus will require extra antenatal visits
to the obstetric doctors compared to the routine antenatal
service. The doctors will want to make sure that the baby is
growing as it should and that you do not suffer any changes in
the lupus disease throughout the pregnancy. Ideally, you are
seen by both an obstetrician and a lupus doctor in these clinics
but this is not always possible, in which case you will need to
see the doctors in separate clinics.
What are the risks once I am pregnant?
Lupus is more likely to be stable during pregnancy if the disease
was stable before pregnancy. Some women do have flares of
lupus during pregnancy and need careful observation. The
flares are usually mild but may need treating. Women at
particular risk are those in whom the lupus has affected the
kidneys, heart and brain in the past or at the beginning of
pregnancy. Women whose disease is active when they
become pregnant have the most problems from lupus during
pregnancy and are likely to need additional drug therapy as the
active disease can affect the development of the baby, as well
as making the mother unwell. Lupus kidney disease needs
particularly careful monitoring as there are no symptoms from
this and, if uncontrolled, can seriously affect the health of
mother and baby long-term.
Women with lupus are more likely to suffer from high blood
pressure in pregnancy (pre-eclampsia) and this may occur in 1
in 5 lupus pregnancies. The risk is higher in women with antiphospholipid
syndrome (about 1 in 3 pregnancies).
Lupus and anti-phospholipid syndrome may affect the way the
afterbirth (placenta) works. In early pregnancy if the placenta
fails to work miscarriage will occur. Women with antiphospholipid
antibodies are particularly at risk of this
complication as their blood is more "sticky". Specific treatment
is advised in this group of women and tests will be performed
to look for these antibodies if you have had a previous
miscarriage or stillbirth.
All women with lupus have about 25% risk that the baby may
not grow optimally within the womb and may need early
delivery. For this reason regular ultrasound examinations of
your baby are advised.
Do I have to have a Caesarean Section?
Patients with lupus do not have to have a caesarean section.
However, care is individualised and if problems arise with either
you or the health of the baby during pregnancy this may
become necessary. The way your baby will be delivered is
usually discussed in the last 3 months of the pregnancy.
What happens after I have had my baby?
Some ladies do have a "lupus flare" within the first three months
after giving birth, so make sure you have an appointment with
your lupus doctor within three months of having your baby. This
is also a good time to review your medications again.
Can I breast feed?
It is usually safe to breastfeed if your tablets remain the same as
they were while you were pregnant. Make sure that your doctor
knows you are breast feeding so that he/she can ensure that
your tablets remain appropriate until you stop breast-feeding.
Should I have my baby tested for lupus?
It is not a good idea to have your baby tested for lupus as there
are no tests that reliably predict susceptibility to lupus. Lupus
occurs in less than 10% of children born to mothers with the
disease. Your genes have been mixed with your partners so
there is a good chance that your baby will not inherit enough
genes to cause lupus. Even if the baby inherits some genes for
lupus there are other unknown factors that determine whether
and when someone develops lupus, and most babies born to
mothers with lupus never develop the disease, particularly if it is
a boy as the disease is more common in females.
My baby had a rash when it was born,
does this mean that it has lupus?
Babies have some of the mother's blood products (antibodies) in
them for about three months after they are born. This means that
some babies develop a "lupus-like" rash after birth (neonatal lupus
syndome). There is no evidence that these children go on to
develop the disease lupus and the rash usually fades over 6
months. It can be avoided by not putting the baby in sunlight. It
occurs in about 10% of babies born to mothers with anti-Ro
antibodies and does not occur in the absence of this antibody.
I've heard that some babies born to
mothers with lupus have a slow heart
rate when they are born?
Some mothers have particular antibodies called anti-Ro or anti-La
antibodies that may cross the afterbirth (placenta) from week 16
onwards and stick to the "electrical circuits" within the baby's
heart. You will be tested for these antibodies before or when you
become pregnant. If you carry these antibodies it means that there
is a 1:100 (1%) chance that your baby may develop a slow heart
rate in the womb. For this reason the midwife will need to check
the baby's heart rate weekly from week 16. Monthly ultrasound
examinations noting the fetal heart rate are also recommended. In
the rare event that the baby's heart is slow, treatment and more
close observation will take place under the care of specialist
paediatricians even before the baby is born.
I have anti-phospholipid syndrome.
How does this affect my pregnancy?
This condition means that your blood is more "sticky" than it
should be. Pregnancy also makes blood "stickier" in people
without this condition, so that it can be a more significant problem
in pregnancy than when you are not pregnant. This means that
you are more prone to miscarriages than other women, as the
small blood vessels of the after birth (placenta) may become
blocked by blood clots, depriving the baby of essential nutrients.
This condition can also affect the well-being of the mother herself,
and she is more prone to developing blood clots within the blood
vessels of the body in pregnancy.
As soon as you discover that you are pregnant you must contact
the hospital and be started on the appropriate medication. If you
have previously had blood clots (for example deep vein
thrombosis in the leg or pulmonary emboli in the lungs) you will
usually be treated with aspirin and injections of heparin that you
will be taught to give to yourself. You will also need very careful
follow up throughout the pregnancy and for several weeks
following the birth of your baby. Treatment for women with a
history of recurrent miscarriages, stillbirth or pre-eclampsia
associated with anti-phospholipid syndrome depends on the
exact details of the previous events and the results of blood tests.