Hi Alisia,
The issue of trying for a baby is a big one for lots of us with lupus. Logical really when you think that the main group of people who get lupus is young women - just the group who also have babies.
Many years ago doctores advised women with lupus not to get pregnant, but we now know that with good medical care women with lupus can get pregnant and have healthy babies.
Pregnancy with lupus remains a 'high risk' situation. That means that there are potentially things that can go wrong, so being seen more often by an obstetrician is advisable. It is also a good idea that pregnancies are planned, not accidental. That way you can check with your rheumatologist and obstetrician before conception what you need to do about medications and where you need to go once you do get pregnant.
There are some medicines that absolutely cannot be used during pregnancy. These are methotrexate (which will cause a miscarrige if you are on it when concieving), and cyclophosphamide (which causes birth defects).
The lupus medications that have the best safety record in pregnancy are prednisolone, plaquenil and azathioprine (in that order of preference).
The very best case scenario is if someone with lupus is in remission - ie has no symptoms currently and is taking no medications. For lots of us though that is just wishful thinking. The second best option then is getting the lupus as well controled as possible with whatever medications necessary (with the exceptions being those that we know will seriously damage the baby). It is less risk to the baby to have exposure to drugs like plaquenil or pred, that to be carried in a mum who is flaring.
To decide what you personally should do, you should speak to your rheumatologist, and get an obstetrician who specialises in high risk women, and have a pre conception consultation.
There are a few issues that should be looked at specifically. The first one is to be screend for SSA and SSB antibodies - also called anti Ro and anti La. These antibodies are associated with a condition in the baby called neonatal lupus. If you have them you can still get pregnant, but the doctors will keep an extra close eye on the baby to check for heart problems.
The second issue is APS - anti phospholipid syndrome. If you have this, it can cause miscarriages and increase the risk of a smaller than average baby, pre-eclampsia, HELLP and placental abruption, and stillbirth. The treatment is asprin and heparin. This helps improve the chance of a live baby from about 10% to about 70%.
The latest thinking is that for women who do not have APS, and who's lupus has not damaged their organs (especially the kidneys), the chances of having a normal pregnany are pretty much as good as those who do not have lupus. For those who have lupus and APS, getting the right treatment also helps a lot in improving the chance of success.
So, that is pretty good news:wink2:
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