A few decades ago, women with lupus were advised not to become pregnant, since the disease is associated with pregnancy complications.
Today, a better understanding of lupus and new ways to treat potential complications have helped improve the odds of having a successful pregnancy. The percentage of pregnancies with complications is now less than 50 percent and research continues to explore new ways to treat the condition and counter possible complications.
When women with lupus become pregnant it is characterized as a high risk pregnancy, since the disease is associated with a higher incidence of miscarriage, pre-term delivery and preeclampsia. Miscarriage ends at least 10 percent of such pregnancies, while one in five women report complications associated with high blood pressure, including pre-eclampsia. There is also a greater incidence of diabetes and urinary tract infections, primarily in women who take steroids to treat the disease.
Complications are more likely if the woman has a history of certain conditions, including hypertension, kidney disease, previous pre-eclampsia and blood clots.
Lupus is not associated with any difficulty in becoming pregnant but the odds of having a healthy pregnancy may be improved by waiting for the right timing. The best time to become pregnant is when lupus is in remission. The healthier a woman is before conceiving the more likely she is to have a healthy pregnancy. Women who conceive at least six months after the disease is under control are less likely to have a flare during pregnancy.
It’s a good idea to visit a health care provider early in a pregnancy to determine which lupus medications must be discontinued during pregnancy and which are considered safe to use.
Expectant mothers with lupus benefit from consistent medical care, ideally seeing both a rheumatologist and an obstetrician specializing in high risk pregnancies. Seeing a rheumatologist once every trimester is recommended. In general prenatal care visits will be more frequent and may be more involved, with monthly blood and liver function tests as well as a urine analysis.
Even if a woman is healthy when she becomes pregnant, the surge in hormones associated with pregnancy can occasionally cause a lupus flare up. To prevent a flare up women are advised to get plenty of rest, avoid stress, sun exposure, alcohol, cigarettes and recreational drugs. Reporting symptoms to a healthcare provider as soon as possible is an essential part of controlling a flare up.