In a separate post, we looked at some of the main considerations for a woman diagnosed with lupus (Systemic Lupus Erythematosus, or SLE) who desires to become pregnant.
Here we continue that discussion, focusing on how a pregnant woman and her baby might be impacted under these circumstances. It’s crucial that all women suffering from lupus understand that the chance of complications during pregnancy is drastically reduced if the disease has been quiet, without any flares, for at least six months prior to conception.
What are pregnancy complications that could result from my lupus?
Disease flares brought on by pregnancy are relatively rare and usually very treatable. However, there are several complications that may arise from your condition while pregnant; many of these, including renal issues, tend to be milder when SLE kidney disease is in remission. According to the Mayo Clinic, the three major potential problems during pregnancy are preeclampsia (high blood pressure), pre-term birth, and miscarriage. Besides these three, other complications that are more rare but possible include infection, thrombosis (clotting), reduced platelet counts and hemorrhage. While vaginal delivery is generally possible, there is also a higher incidence of caesarean sections in mothers with lupus. The major risks to the fetus are growth retardation, low birth weight, and to a lesser extent, neonatal lupus and fetal loss.
What is the treatment, and are the complications to the baby considered high risk?
As with any medical complication, the treatment and level of risk to the baby will vary widely depending on the specific problem. Since the only true treatment for preeclampsia is delivery of the baby, such an issue must be considered by weighing the risk of related complications versus that of premature delivery. For infections, the mother would likely be treated with antibiotics, and anti-clotting therapy may be attempted for clotting issues, at the doctor’s discretion. When platelets are low, the treatment is high-dose prednisone and intravenous immunoglobulin (IVIG). And postpartum bleeding, if severe enough, would require a blood transfusion. As noted above, renal (kidney) involvement definitely increases the risk to both mother and baby, and pregnancy should be avoided during times when this is evident.
Is the risk for complications higher in certain trimesters?
This is an important question with treatment implications, and the answer is yes. In general, the first and second trimesters are more likely to see complications versus the third. Since many of these potential complications can result from the medications lupus patients take, if possible, most of the drugs used to treat lupus should be avoided during the first trimester, with these restrictions becoming less stringent as the pregnancy proceeds. Your physician(s) will determine which meds are safe and at which time during pregnancy.
Do studies show an increased chance for pre-term delivery in moms with lupus?
Yes, both research and observation have shown a definite increase in pre-term deliveries for those diagnosed with lupus. However, according to the Lupus Foundation of America, this does not necessarily mean there will be any problems, and most women who fit this description will still deliver a healthy, viable baby. As their website notes, “Normal children are the rule,” not the exception. This of course requires that all instructions and precautions are followed, and any new symptoms or flares are reported to your physician immediately.
Questions for your doctor:
- Given my disease state and history, what specific signs and symptoms should I be most concerned about and report ASAP?
- Can you recommend where I might find a comprehensive list of possible complications and what to do in case they arise?
- How will my condition affect my treatment during pregnancy? Can any of my meds lead to certain complications?
- Can I personally do anything to reduce the risk of problems to my baby and me?
- Will I be able to breastfeed, and what if any problems might arise from doing so?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].