Pregnancy can be quite tricky. While we know many diseases can pass to the fetus in the womb, from the mother, how many can actually affect the baby? What about SLE and pregnancy? Is it safe for a woman with SLE to have a child? Can the baby get affected if the mother-to-be has SLE?
The mother-to-be is always worried about what will affect or harm her unborn child. This includes ways and means by which she herself might harm the child. Genetic transmission is one such real concern for any mother to be. Read on to find out everything about SLE and pregnancy.
In This Article
- What is Systemic Lupus Erythematosus(SLE)?
- Can a Lupus Patient Have a Successful Pregnancy?
- Right Time to Conceive and To-Dos After Becoming Pregnant
- When Not to Conceive With Lupus?
- Can Pregnancy Worsen Systemic Lupus Erythematosus?
- Symptoms of Lupus Flare During Pregnancy
- Complications of SLE in Pregnant Woman
- Safe Systemic Lupus Erythematosus Medications During Pregnancy
- Is Vaginal Delivery Possible For Lupus Patients?
- Effects of Maternal Lupus on the Foetus
- Lupus in Newborn
- What Should New Mothers With Lupus do Post Pregnancy?
What is Systemic Lupus Erythematosus(SLE)?
Let us start at the very beginning. Let’s first understand what exactly SLE is before we move on to conceiving or genetically passing it down to the next generation.
SLE or Systemic Lupus Erythematosus is an autoimmune disease, the cause of which is still unknown. Doctors and scientists believe that it could be due to genetic or hormonal factors or even due to environmental exposures. There is no cure for this idiopathic disease which affects more young women from various ethnicities.
Can a Lupus Patient Have a Successful Pregnancy?
The answer is yes, a woman with SLE can go ahead and have a healthy and successful pregnancy. Lupus affects women between the ages of 15 and 44, and mothers-to-be mostly fall into this age group. Now, the biggest concern and question is – can a woman diagnosed with SLE have a successful pregnancy? Can she have a healthy child or will the child inherit this disease genetically? Yes, she can. However, she will be classified as a “high-risk” pregnancy; meaning there can be unexpected complications that can even affect the pregnancy. This does not mean all women with Lupus will have complications in their pregnancy. It is just a high possibility.
Every pregnant woman is vulnerable to contracting some illness or experiencing some complications during the course of her pregnancy. Women with Lupus have a higher chance of this possibility. As long as the disease is well under control and the woman is under constant observation of a medical professional, she can go ahead and have a very happy and successful pregnancy.
Right Time to Conceive and To-Dos After Becoming Pregnant
A woman with Lupus cannot get pregnant at any time. It is not safe unless her disease is under control. The disease must be inactive or under control for at least 6 months before the woman can get pregnant. Conceiving when the disease is active can cause severe flare-ups, resulting in a miscarriage, stillbirth, or various other health issues for the baby.
If a woman with Lupus wants to get pregnant, she definitely needs to plan more than the average woman. Pregnancy can worsen the health condition or cause new issues for the expecting mother.
Conditions That Can Increase the Risks For a Pregnant Woman With Lupus
Women with the following conditions combined with Lupus are at a higher risk
- Lung disease
- High blood pressure
- Kidney disease
- Chronic kidney failure
- Preeclampsia
- A lupus flare within the last 6 months
Despite the risks, a woman suffering from lupus can still have a safe pregnancy and delivery with proper medical guidance and a few precautions.
Safe Pregnancy Tips For a Woman With Lupus
If you are a woman with Lupus and are planning to get pregnant, here are a few tips to follow, to ensure a safe and healthy pregnancy
- Consult your doctor to ensure your disease is not active and has been so for the last few months.
- Find a gynaecologist/ obstetrician who specializes in high-risk pregnancies or pregnancies with lupus.
- If you are comfortable with your gynaecologist, who is not a specialist in high-risk pregnancy, find an obstetrician who is a specialist in such pregnancies, and can work with your doctor, to take care of you.
When Not to Conceive With Lupus?
Now that we saw what has to be done when a woman with lupus conceives, here are a few instances where pregnancy is not recommended for a woman with SLE:
1. Early Stages of SLE or When SLE Has Just Been Diagnosed
Since the doctors are not clear about how far the disease has or will affect the woman, it is not safe to get pregnant at this time. The woman will mostly be advised to postpone the pregnancy plans. Immunosuppressant medications will also be adjusted to make it safe for conception.
2. If SLE Has Severely Damaged One or More Organs
In such severe cases, pregnancy can add to the complication and the strain on the organ, thus posing a threat to the life of the woman. If the organ damage is severe, doctors will strongly discourage pregnancy.
Can Pregnancy Worsen Systemic Lupus Erythematosus?
We all know pregnancy can play havoc with hormones. A pregnant woman’s hormones fluctuate a lot leading to a lot of health issues, most of which subside after the pregnancy comes to term. Does pregnancy affect the existing Lupus condition? Does it have a positive or negative impact on this autoimmune disease?
Yes, sadly it can. If you are pregnant and your lupus is active, it can cause issues. The hormonal fluctuations and other changes in the body can lead to flare-ups.
Women with a pre-existing condition of Lupus are at the following risks, if and when they get pregnant:
1. Flare During Pregnancy
You can experience a flare-up in the first or the second trimester, where hormonal changes are at the maximum. While some of these flare-ups can be very mild, some can be very severe and cause a miscarriage or other issues with the pregnancy.
2. Preeclampsia
This is a serious condition that can cause very high blood pressure as well as issues with the kidney, and various other organs. It can result in pre-term labor.
3. Additional Health Conditions
Increase in risk for other pregnancy-related health issues like gestational diabetes, gestational blood pressure, and kidney problems.
Lupus is an autoimmune disease where the immune system attacks the body instead of protecting it. When you are pregnant and your immune system starts attacking your body and causes damage to the cells and organs, it can complicate your pregnancy. A pregnant woman needs all her energy and strong immunity to ensure the safety of the unborn child and herself.
If the disease is attacking your joints and muscles, causing severe inflammation and pain; this combined with pregnancy pains is not something doctors would recommend. This is why it is important to get the SLE under control before planning for a pregnancy.
Symptoms of Lupus Flare During Pregnancy
If your Lupus is under control before conception, there is a good chance for you to have a complication-free and healthy pregnancy. Your lupus can be stable and maintained well throughout the pregnancy. If you have SLE and are pregnant, there are chances of a flare-up, thanks to all the hormonal fluctuations. It is important to keep a close lookout for the following symptoms and to seek medical help immediately. Pregnancy is not a time to take any chances or to wait it out.
Here are some symptoms of lupus flare during pregnancy.
- An increase in fluid build-up in the joints causes more pain and discomfort
- Joint pains
- Postpartum hair loss
- Changes in the skin – flushes, rashes, or darkening of the skin
- Fatigue
- Shortness of breath
Now, these are very common among pregnant women aren’t they? We can hardly come across a pregnant woman who does not complain of one of the above. So, these symptoms can be easily confused with regular pregnancy-related discomforts.
Paying Attention to Symptoms is Vital
Skin darkening can be confused with pregnancy melasma, which has no cure and the patches can stay on forever. Similarly, with post-partum hair loss, no new mother would even consider Lupus as hair loss is a very common issue with new moms. Similarly, one can always get confused with other symptoms too and not get checked for Lupus unless the symptoms are severe. However, if you are a lupus patient and pregnant, you need to be extra cautious when you experience these symptoms. Always keep your doctor informed so that they can ask for further tests if they suspect it to be a Lupus flare.
Now, you may think these “lupus flare” symptoms are the same as any other pregnancy-related symptom and hence lupus need not cause any complications in the pregnancy after all. In many cases, if the lupus is kept under control, it does not cause any complications. However, these common symptoms can be much more severe when it is caused due to a lupus flare. It can lead to many other complications as well.
[Read : Hypertension In Pregnancy]
Complications of SLE in Pregnant Woman
Lupus is an autoimmune disease. So, the cause of the disease cannot be determined, and there is no cure either. When a woman diagnosed with Lupus gets pregnant, there are high chances for some complications to occur. These can however be controlled or managed if the woman is under constant observation for flare-ups.
Some of the possible complications Lupus can cause during pregnancy are:
- Hypertension is a very common complication related to pregnancy, even in healthy women. When it comes to women with Lupus, it only increases the chances.
- Preeclampsia, along with hypertension, this can result in high protein content in the urine.
- Increases risk of a miscarriage.
- Preterm labour (i.e) When labour occurs before the 37th week of pregnancy.
- Increased risk of blood clots in the lungs and legs.
- Higher chances for an emergency cesarean section delivery.
- Excessive bleeding after delivery.
Does this mean Lupus’s effect on pregnancy stops with the mother? Any mother would prefer this outcome rather than the disease affecting their newborn. Sadly, Lupus can affect the baby too.
Safe Systemic Lupus Erythematosus Medications During Pregnancy
Pregnant women are taken off most of their medications, for the fear of affecting the baby. Doctors hesitate to give any medication unless they have no other choice. In most cases, antibiotics are avoided if the woman is pregnant.
The reason is, the contents of the medicine can pass to the baby through the mother’s blood, and can have some severe effect on the baby. Sometimes, it can harm the pregnancy itself. So, what about your medicines for Lupus?
Here is a list of commonly used medicines for Lupus and if they are safe or not during pregnancy.
1. NSAIDs
To be used very cautiously and only in the first two trimesters. Should be avoided after 32 weeks of pregnancy.
2. Aspirin
Safe. In fac.t it is recommended for women with a high risk of preeclampsia. It causes no harm to the mother or the baby.
[Read : Aspirin During Pregnancy: Is It Safe or Not?]
3. Paracetamol
Safe if used intermittently
4. Corticosteroids
Safe. It in fact has more benefits than negative impacts.
5. Immunosuppressants
Safe and should be continued till the end of the pregnancy
6. Azathioprine
Safe but should be used only as little as possible.
7. Tacrolimus
Safe and usage has to be slowly reduced
8. Cyclosporine
Safe to continue but consulting your doctor once before continuing these medicines, is crucial.
9. Mycophenolate
Safe only before pregnancy. Once pregnancy is confirmed, the medicine has to be discontinued.
10. MTX
Stop this medicine at least 3 months before planning to conceive.
Is Vaginal Delivery Possible For Lupus Patients?
Yes, it definitely is a possibility. If the lupus is brought under control, the woman can have a vaginal delivery. However, if the lupus is still active it can lead to flare-ups during the pregnancy, resulting in an emergency C-section delivery. There are high chances for active SLE to cause preeclampsia, kidney-related problems, or damage various organs in the body. This can result in a pre-term or an emergency cesarean delivery as well.
When the disease is inactive and the woman is under constant medical supervision, a vaginal delivery is definitely possible.
Effects of Maternal Lupus on the Foetus
Everyone is worried about what effect the mother’s disease can have on the unborn child. It is not a worry restricted to Lupus but to almost all illnesses, be it genetic or otherwise. It is a natural worry and no mother wants to leave any stone unturned when it comes to protecting her child from something she is suffering from.
Lupus can have the following impact on the unborn child:
1. Effects on Placenta
The antibodies produced by the body to fight lupus can cause blood clots and disrupt the functioning of the placenta. The placenta is the organ through which the fetus is nourished within the womb. When the placenta is unable to perform its role due to these antibodies, it affects the baby. If the baby does not receive sufficient nutrients, it can have a severe impact on the fetus’ growth.
2. Preeclampsia
If preeclampsia is left untreated or is not treated in time, it can cause severe damage to both the mother and the baby. It can even lead to a miscarriage or a preterm delivery, both of which can affect the baby directly.
[Read : Preeclampsia Causes, Symptoms, Risk Factors, Treatment]
Lupus in Newborn
The Lupus antibodies found in the mother’s body can cause symptoms similar to lupus in the baby. It is a rare condition called neonatal lupus. The symptoms include a skin rash, heartbeat irregularities. In most cases, this neonatal lupus will subside and go away within a period of 3 to 6 months and not come back. However, in a few rare cases, it can get worse and affect the baby’s heart. It can cause congenital heart block, which is a serious defect in the heart.
Caring For Newborn:
As a mother, there will always be a concern on your part about your little one inheriting lupus from you, and what you, as a parent can do. Here are a couple of pointers.
- Doctors will check the newborn for neonatal lupus if the mother has lupus. If the hospital fails to do this test, ensure you get them to do it.
- Certain medicines can pass through breast milk and affect the baby. Talk to your doctor and find out which medicines have to be discontinued or replaced, when you start your breastfeeding journey.
What Should New Mothers With Lupus do Post Pregnancy?
Sadly, your Lupus is going nowhere. If you are suffering from Lupus, there is no permanent solution or cure for this condition. Now, with a new baby on board, you need to care not just for the baby but for yourself too. Your Lupus has to be monitored and kept under close supervision despite the baby taking all your time.
Self Care Post Pregnancy:
Here is what you should do for yourself if you have Lupus and a new baby:
- Postpartum causes a lot of changes in a woman’s body. It is easy to get lupus symptoms confused with postpartum symptoms.
- Anytime you experience new symptoms or existing symptoms seem to get worse, contact your doctor immediately.
- Breast-feeding can cause a lot of hormonal fluctuations in the lactating mother’s body. Talk to your doctor if you find any new symptoms including depression, too much fatigue or any other physical symptoms.
Getting pregnant and giving birth to their own child is a dream for most women, including those with a severe case of SLE. SLE need not necessarily stop you from starting a family of your own. With proper guidance and care, women with lupus can go ahead and have a good and healthy pregnancy, resulting in healthy children.
Read Also: Intrauterine Growth Retardation
