If you’re living with lupus and ready to start or grow your family, you’ve probably done a Google search or two to see how your body might handle a pregnancy. As with other lifestyle changes, you’ll need to consider your current activities, energy level, eating habits, and medications and how those might change with the addition of a new little bundle of joy. Lupus is different for every patient, just as pregnancy is different for every mother. Make sure to attend all prenatal visits and consult with your doctor, rheumatologist, and healthcare team for information that is specific to you.
Let’s dive right in and answer some of those burning questions! The information in this article is adapted from the sixth edition of The Lupus Book.
How does lupus affect fertility?
The majority of people with lupus are able to conceive and manage both pregnancy and lupus symptoms. Active disease, kidney issues, and some chemotherapy drugs can cause irregular periods or early menopause, which impacts ovulation and the ability to conceive. Once the lupus activity is managed and periods are regular, then women with lupus can get pregnant with the same success rate as the general population. “All told, two thirds, or 67 percent, of all lupus pregnancies produce a successful birth.” Men who are taking chemotherapy drugs will experience a decrease in sperm count, so it is advised to save sperm in a bank before beginning chemotherapy.
How does pregnancy affect women with lupus?
Pregnancy with lupus can be described as low-risk, moderate-risk, or high risk.
Low-risk patients have the same risk as the general population.
Moderate-risk is the most common and presents little chance of a serious flare during pregnancy.
High-risk can be life-threatening to the mother or result in loss of the baby.
What if I have or develop Antiphospholipid Syndrome?
Antiphospholipid Syndrome is present in about ⅓ of lupus patients and “in these patients the risk of spontaneous abortions ranges from 20 to 50 percent. Antiphospholipid antibodies cross the placenta and promote clots in it, which results in fetal death.” It is still possible to conceive and maintain the pregnancy. There are various treatment options which you can discuss with your healthcare team.
What if I carry the Ro (SSA) or La (SSB) antibody?
Ro (SSA) antibodies, and many times La (SSB) antibodies, are present in about 20 to 30 percent of patients with lupus. “Anti-Ro and anti-La can cross the placenta and induce two syndromes: neonatal lupus and congenital heart dysfunction or block. It is very rare that the mother or baby will be affected, and if necessary, treatment is possible during pregnancy. “Even though congenital heart block in the infant is found in less that 5 percent of pregnancies if of Ro-positive mothers, pregnant women should be screened for it with a fetal echocardiogram (ultrasound of the heart) at weeks 18 through 24.”
What if I have active Kidney Disease?
If you have Kidney Disease, there is a 50% chance that you could flare during pregnancy. It is important to work closely with your healthcare team to monitor renal function throughout your pregnancy.
Which lupus medications can I take while pregnant?
This is not a complete list of medications, please consult with your doctor before starting, stopping or changing any medications or doses.
Generally safe medications:
- Prednisone
- Hydroxychloroquine
- Intermittent NSAIDS
- Apheresis
- Intravenous immune globulin
Medications that should be monitored:
- Cyclosporine
- Tacrolimus
- Azathioprine
- Belimumab
- Tocilizumab
- Abatacept
- Rituximab
Do not take these medications:
- Regular dose or daily NSAIDS
- Methotrexate
- Leflunomide
- Cyclophosphamide
- Mycophenolate mofetil
Can my baby get lupus from me?
The chances of your baby developing lupus are slim. “In other words, fewer than 10 percent of patients who carry a lupus gene will ever develop the disease.”
Can I breastfeed my baby?
Yes, you can breastfeed for up to 3 months before returning to your regular lupus medications and management. “The only anti-lupus drug that is safe to use with breastfeeding is prednisone.” Other medications or chemotherapies can be passed to the baby through breastmilk and are therefore not recommended while breastfeeding.
This is such an exciting time and we are happy to help ease your worries as you prepare for this next step in life!
For more information about lupus and pregnancy, see the most recent edition of The Lupus Book. Schedule a visit with one of our compassionate doctors at Wallace & Lee Center if you have further questions about your treatment options.