Systemic lupus erythematosus (SLE), commonly referred to as lupus, is an autoimmune disease that overwhelmingly affects women, which means there are certain considerations for patients who are or are looking to become pregnant. Below we discuss some aspects of this disease during this very specific state of health in women of childbearing age.
What are some considerations for planning to become pregnant if I have lupus?
First and foremost, you’ll want to discuss this with your internist, ob/gyn and rheumatologist (as well as a nephrologist if there is kidney involvement) before proceeding, to get their thoughts and opinions regarding your condition. Pregnancy may sometimes lead to flares in the disease, thought this is not always the case, and they are usually mild.
In addition, the proportion of women experiencing flares seems to have decreased substantially in recent decades, though the cause is uncertain. According to the NIH, lupus pregnancies are higher risk, though most mothers carry to term safely. Still, it is recommended that women in this category have more prenatal visits with more frequent antibody testing (to monitor levels) and complete blood counts (CBC), and they may be referred to a maternal-fetal medicine obstetrician (MFM) who specializes in high-risk pregnancies. Also, as noted by the Lupus Foundation, “Many experts recommend trying to get pregnant after the lupus has been quiet (no flares) for at least six months,” though this is not a hard and fast rule.
Because lupus does increase the chances for certain complications during pregnancy (which will be covered in another article), it is crucial that the above recommendations be followed, as well as any special instructions from your doctor. And as with any special circumstance during a pregnancy, any changes or new symptoms should be reported to your doctor(s) immediately.
Will I still be able to take my medicine while pregnant and breastfeeding?
This really depends on which medicines you are taking, and the timing between stopping any that are potentially detrimental and becoming pregnant or breastfeeding. It is something you will want to carefully discuss with your physician, preferably long before becoming pregnant. He or she will be the only person who can tell you exactly which of your meds are safe for consumption while pregnant or breastfeeding, and which should be avoided. Since there are so many medications used in the treatment of lupus, it’s hard to give a more definite answer without considering each patient’s individual circumstances and treatments. But because there is a considerable list of medications that are safe versus unsafe, any patient considering having a baby should become familiar with the classifications of those she is currently taking.
There are certain medications, such as methotrexate and others, that are absolutely incompatible with pregnancy, having demonstrated dangerous effects on the fetus. For women on such meds, contraception should always be used while actively taking them, and they should discuss how long to be off such medications before attempting to become pregnant.
As noted by Medscape, “None of the medications used in the treatment of systemic lupus erythematosus (SLE) is absolutely safe during pregnancy…during the first trimester, most of the drugs should be avoided.” Because of the large number of available choices for lupus patients, your doctor will, in most cases, be able to find treatments that minimize this risk and offer the best chances for a healthy full-term baby, while also treating your condition.
Are there any studies that show a common time period in the post-partum weeks for the condition to normalize back to my pre-pregnancy condition symptoms?
Years of observation have shown that women may experience disease flares in the post-partum period, though the intensity and duration of such occurrences can be quite variable and patient-dependent. While no specific studies were found determining this particular parameter (most post-partum lupus research deals with very specific conditions or complications), experience has shown that post-partum symptom flares are generally worse for those women who had active disease at the time of conception, versus those who did not. Definitely speak to your treating physician for more information specific to your personal condition and the likelihood of any post-partum issues.
Questions for your doctor:
- How often should I come in for prenatal visits if I have diagnosed SLE and become pregnant?
- Which of my medications can I take, and which should be stopped before/during/after pregnancy? When should I stop those that are considered unsafe?
- What are the risks of complications to my baby and myself during this period?
- Which lab tests are necessary during pregnancy and why?
- What events/situations are considered “normal” for SLE patients during pregnancy, and which should be considered worrying or warrant a call to the doctor?
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].