Lupus and Pregnancy: What Every Expecting Mother Should Know

What Is Lupus?

Lupus is an autoimmune disorder in which the immune system mistakenly attacks its own healthy tissues and organs, causing inflammation across the body. It can affect a patient’s joints, kidneys, blood cells, skin, brain, heart, and lungs. It may be caused by genetic factors, reaction to hormones like oestrogen, environmental factors (pollution, harmful sunlight, etc.), smoking, chronic stress, and other underlying conditions. Also known as systemic lupus erythematosus (SLE), the disease can take different forms. While the most common type affects the entire body, others include:

1. Cutaneous lupus erythematosus: Affects only the skin
2. Drug-induced lupus: Caused by medication as a side effect.
3. Neonatal lupus: Sometimes, babies might be born with lupus. 

Symptoms of lupus and their intensity vary from person to person. Some of the most commonly noticed symptoms include:

• Fever
• Shortness of breath
• Tiredness
• Joint pain
• Stiff or swollen joints
• Butterfly-shaped rash across the cheeks. Harder to see on dark skin. 
• Chest pain
• Headaches
• Confusion or memory loss
• Hair loss
• Mouth sores
• Swollen glands

The symptoms of lupus occur in intervals known as “flare-ups”. When your body is going through a flare-up, the symptoms may be so severe that they affect your daily routine. At other times, the symptoms can be mild, or you may not feel anything at all. 

Can Women with Lupus Have a Healthy Pregnancy?

A healthy pregnancy with lupus is possible, but the risk of complications is great. The risk may be even higher if the mother has high blood pressure, kidney problems, blood problems, or has proteins in her blood that can increase the chances of blood clots and miscarriage (antiphospholipid antibodies). While women with lupus can have successful and healthy pregnancies, it is still considered high risk and requires close monitoring by her care team. You can work together with your rheumatologist and other healthcare providers to create a plan that works best for you.

How Does Lupus Affect Pregnancy?

Lupus can increase the risk of complications for both the mother and the baby.

Risks to the Mother

Lupus pregnancy complications include:

• Flares of lupus
• Pre-eclampsia
• Kidney disease 
• Blood problems such as blood clots 
• Miscarriage

Risks to the Baby

Lupus also poses a risk to the baby, including:

• Lupus also poses risks to the baby, including:
• Preterm birth
• Foetal growth restriction
• Loss of a baby at birth or miscarriage
• Neonatal lupus

Can Lupus Increase the Risk of Miscarriage?

Lupus and miscarriage are two terms often linked to each other. Women with lupus are more likely to have a miscarriage during pregnancy than women in the general population. The risk, however, varies from person to person depending on disease activity and antibody status. Losses in the later months of pregnancy are linked to antiphospholipid antibody syndrome, making it necessary for pregnant women to be screened for antiphospholipid antibodies.

According to studies, the rate of pregnancy loss in women with SLE has decreased over the years. However, it remains high compared with pregnancies in healthy women. About 20% of all pregnancies in patients diagnosed with lupus end in miscarriages.

How Does Lupus Affect Fertility?

While lupus by itself does not cause infertility directly, it can cause complications and negatively impact your chances of conceiving. In men, too, inflammation due to lupus can affect sperm quality and quantity. Women diagnosed with SLE have fewer children as compared to healthy women, as per research. According to a study where a total of 136 infertile women were evaluated, 1.5% of them had undiagnosed SLE.

So, how does lupus affect fertility? Indirect causes may include cytotoxic and other medications, ageing, and psychosocial effects of the autoimmune disease. Monthly cyclophosphamide injections, a type of treatment for lupus, may also induce premature ovarian failure in women.

It has also been studied that women with lupus are more likely to have irregular menstrual cycles. This may be due to the systemic inflammation caused by the disease or the medications used in treatment. Patients with lupus may also have higher levels of some antibodies that can affect pregnancy.

Preparing for Pregnancy with Lupus

If you have already received a lupus diagnosis, there are certain steps you can take to make sure your pregnancy goes smoothly.

• Achieving disease remission or low disease activity for at least six months prior to conception.
• Have a rheumatologist review medications to discontinue those considered unsafe in pregnancy and switch to pregnancy-compatible alternatives well in advance.
• Antibody testing (e.g., antiphospholipid antibodies, anti-Ro/SSA, and anti-La/SSB), as these impact pregnancy management and monitoring.
• Baseline kidney health is a strong predictor of pregnancy outcomes, so it is best to measure kidney function and blood pressure beforehand.
• Coordination of care with a rheumatologist and an obstetrician who specialises in high-risk pregnancies before, not after, conception.

Remember, outcomes are not guaranteed, but it is better to take any and all precautions that you can before conception. A healthy pregnancy with lupus is absolutely possible, and proper planning will only boost your chances.

Managing Lupus During Pregnancy

Once a positive pregnancy test is in your hand, things can get overwhelming with lupus in the mix. However, managing lupus along with pregnancy is possible. For starters, make sure you are attending frequent monitoring visits with your healthcare provider to track blood pressure, kidney function, and disease activity. These visits are often more frequent than a standard pregnancy schedule. Other tips include:

• Routine foetal ultrasound for growth and foetal heart rhythm monitoring in antibody-positive patients.
• Continuing safe medications with the approval of your healthcare provider.
• Routine recommendation of low-dose aspirin for the reduction of preeclampsia risk in high-risk pregnancies.
• Any new symptoms should be evaluated quickly. It takes clinical experience to distinguish between a lupus flare and normal pregnancy changes like fatigue or mild oedema.

Pregnancy Complications Associated with Lupus

Pregnancy lupus complications include:

• Preeclampsia: This is one of the biggest risks for women with lupus during a pregnancy. It is characterised by high blood pressure and signs of stress on the organs, most commonly the kidneys or liver. Doctors will often do certain blood tests and antibody markers to help tell the difference between preeclampsia and a lupus kidney flare, as the two conditions can be mistaken for each other.
• Preterm Birth: Women with lupus have a higher rate of preterm delivery than the general population. This risk is increased with active disease, hypertension, preeclampsia or antiphospholipid syndrome. One reason that women in their third trimester are monitored more closely is the risk of premature birth.
• Foetal Growth Restriction: The baby may not develop at the expected rate due to restricted blood supply from the placenta to the fetus. Regular growth ultrasounds will help identify this issue earlier and allow adjustments to delivery timing.
• Neonatal Lupus: Neonatal lupus is a rare condition caused by maternal anti-Ro/SSA or anti-La/SSB antibodies crossing the placental barrier. It most often causes a temporary skin rash that goes away on its own within months.
• Antiphospholipid Syndrome and Pregnancy: Antiphospholipid syndrome (APS) is an autoimmune clotting disorder that affects a substantial percentage of lupus patients. It is strongly associated with recurrent miscarriage, stillbirth, pre-eclampsia and foetal growth restriction.

Can IVF Be Considered for Women with Lupus?

Assisted reproductive technology (ART), such as in vitro fertilisation (IVF), can be a good option for women diagnosed with lupus who are facing the risk of infertility. However, they may face some challenges along the way. Since IVF at times would require hormonal manipulation during the pregnancy, there is an increased risk of SLE flares.

After Delivery: Postpartum Care

A woman in general is extremely vulnerable during her postpartum period. Those diagnosed with lupus need extra postpartum care to ensure their well-being, as flare risk can be high during the weeks or months following delivery. Postpartum care with lupus typically involves:

• Look for symptoms of a flare, such as joint pain, rash, fatigue, or changes in the kidneys.
• Medication review, especially for women who are breastfeeding, as not all lupus medications can be taken when one is breastfeeding.
• Women with antiphospholipid syndrome need to stay on antithrombotic treatment, often for weeks after delivery, because the risk of clotting continues to be high after birth.
• Emotional and mental health support, as managing a chronic illness and a new baby can be physically and emotionally difficult.

Conclusion

Getting pregnant with lupus is intimidating, but it doesn’t have to mean that all your dreams of having children have to be shelved. All that a diagnosis of lupus means is that planning your pregnancy and managing it would require some work. With disease control before conception, appropriate medication management and regular monitoring during pregnancy and the postpartum period, most women with lupus can look forward to good outcomes for themselves and their babies. The most important factor for managing lupus and pregnancy safely is open communication with a rheumatologist and obstetric team, ideally before conception.