Lupus and Pregnancy

Posted by Elaine Moore Mar 3, 2007

Prior to the last decade, pregnancy was considered to be a risky undertaking for women with systemic lupus erythematosus (SLE). With advances in treatment and a better understanding of autoimmune disease, the current view is that there is no reason a women with lupus should avoid pregnancy unless she has moderate to severe organ involvement (i.e., central nervous system, kidney, or heart and lungs) which would place her at risk. However minimal, there is some increased risk of disease activity in systemic lupus during the first month of pregnancy. If a pregnant woman is monitored carefully, however, the danger can be minimized. A pregnant woman with lupus should be closely followed by both her obstetrician and her rheumatologist.

Although pregnant patients with systemic lupus erythematosus require careful monitoring, the disease course does not typically worsen during pregnancy. And although symptoms in women with SLE tend to flare during the postovulatory or second half of their menstrual cycle with symptoms improving during their menses, whether flares are more common during pregnancy is a controversial topic. While some women experience a mild to moderate flare during pregnancy the frequency and intensity of flares doesn’t appear to be increased when compared to non-pregnant patients.

Risks in Pregnancy

The risk for miscarriage is increased in women with systemic lupus erythematosus. The risk is greatest early in pregnancy and late in pregnancy. Women with SLE who have antiphospholipid syndrome autoimmunedisease.suite101.com/article.cfm/antiphospholipid_syndrome_aps may need anticoagulant therapy and more intensive monitoring. Pre-term labor and delivery are also more likely to occur in pregnant women with SLE.

Symptoms in Pregnancy

During pregnancy, women with systemic lupus erythematosus are more likely to develop high blood pressure (hypertension), diabetes, high blood sugar (hyperglycemia), and kidney complications such as lupus nephritis, especially if they are taking corticosteroids. For this reason, regular checkups and good nutrition are essential.

Treatment in Pregnancy

High doses of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided during the last few weeks of pregnancy. Hydroxychloroquine (Plaquenil) can be used safely during pregnancy and should not be discontinued since this could lead to disease flares. During pregnancy, prednisone, prednisolone, and methylprednisolone are the corticosteroids of choice because they are only minimally transferred to the placental circulation.

Neonatal Care

Although systemic lupus erythematosus is not a congenital disease, a condition of intrauterine growth retardation can occur in women with lupus. Pre-term labor, another risk factor in SLE, can cause premature delivery. For this reason, it is advisable to have access to a neonatal (newborn) intensive care unit at the time of delivery in case the baby requires special medical attention.

Resources:

Handout on Health: Systemic Lupus Erythematosus, Sept 2003 revision, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) accessed February 10, 2007.

Disease Prevention and Treatment, Expanded Fourth Edition, Hollywood, FL: Life Extension Media, 2003.

David Lamont, Systemic Lupus Erythematosus eMedicine from WebMD, Jan 17, 2006, accessed February 7, 2007.

Lupus, Health Conditions, Cedars-Sinai, accessed February 7, 2007.

Michelle Petri, Lupus and Pregnancy, Johns Hopkins University Arthritis Center.