24.02.2014

How to prepare for pregnancy with lupus

For lupus patients, just moving through the activities in daily life can be a struggle.  Living with an unpredictable chronic auto-immune disease like systemic lupus erythematosis (SLE) can also bring up many questions about what the future may hold. Your physician can help you identify the ways in which you can increase your chances to have a healthy outcome to your pregnancy. As noted above, it is true that lupus patients are at a higher risk for developing complications than the general population which is why it is so important to be closely supervised by your rheumatologist and your obstetrician before, during, and after your pregnancy. 1.   Make sure your lupus symptoms are under control- The first thing to do is have a complete physical examination and blood tests by your rheumatologist or primary care giver prior to becoming pregnant to help determine the best time for conception. Hydroxychloroquine is one medication that could and should be continued if taking prior to pregnancy as it has been shown to contribute to better pregnancy outcomes for women with SLE. 4.   Check with your insurance carrier- Make sure that your insurance plan covers you- and your baby’s health care needs, as well as any problems that may arise. 5.   Follow the general recommendations for an optimum pregnancy outcome- Take a supplement that contains at least 400mcg of folic acid, stop smoking and consuming alcohol or recreational drugs, reduce caffeine intake to less than 200mcg per day, test for rubella, varicella (chicken pox), HIV, hepatitis B, and any other inherited genes.
Women with lupus and women without lupus can both expect to experience similar discomforts that can make it difficult to determine whether the symptoms are lupus-related or simply those common during a normal pregnancy. Early or Pre-Term delivery– 3 in 10 lupus patients are more likely to deliver before completing 37 weeks of pregnancy. During labor and delivery, women who have required steroids to control their SLE during pregnancy will receive an increased dose, called a “stress dose” which will help the body respond normally to the physical stress of childbirth. There are no significant risks for the baby, and most lupus patients do give birth to healthy babies. We invite you to read some encouraging stories that were shared with us by women with lupus who have overcome devastating obstacles, such as miscarriage, and go on to have healthy pregnancies, like Morgan’s above. If you're planning on having kids and have received a diagnosis of systemic lupus erythematosus (otherwise known as SLE, or just lupus) you probably want to know whether lupus will affect your ability to conceive and have a healthy pregnancy. Once you've been diagnosed with lupus, it's important to get the condition under control before you start trying for a baby. The good news: As long as your disease is in remission, your odds of getting pregnant aren't any lower than if you didn't have lupus. Once you get pregnant, most health care practitioners will classify your pregnancy as high-risk — even if your disease is in remission.
Just as lupus is treated differently in non-pregnant women, there's no single course of treatment that works for everyone during pregnancy.
Most babies who are carried to term aren't at risk of any additional conditions (there are no increased odds of birth defects, for instance).


About 2 percent of moms with lupus have antibodies in their blood (anti-Ro or anti-SSA), and their babies are born with neonatal lupus. When you're pregnant with lupus, it's important to keep in close touch with your health care team.
If you experience fatigue, soreness or any other symptoms of lupus (hair loss, fever, headaches, swollen joints, anemia, mouth ulcers), it's better to call your doctor right away than to wait for your next appointment. The good news is if you, your obstetrician and the physician who treats your lupus all work together, the odds are very much in favor of a happy outcome that will make all that extra effort more than worthwhile.
It is especially important to measure kidney function and other antibody tests to determine the risks for fetal loss at 10 or more weeks of pregnancy. In addition, choosing to deliver at a hospital with a Neonatal Intensive Care Unit or other advanced facilities, can provide any specialized care that you or your baby may require after delivery.
This is why it is especially important to be closely monitored and have regularly scheduled visits with your obstetrician for the duration of your pregnancy. If you have active lupus symptoms, high blood pressure, active kidney disease, or antiphospholipid antibodies, miscarriage is more likely to occur.
Babies that are born to lupus patients are at no greater risk for birth defects or intellectual disability (also known as mental retardation) when compared to those born to women who do not have lupus.
This is one reason that your physician will regularly monitor your pregnancy, checking for any abnormality in the baby’s heartbeat. An abnormal blood count may also be present. This is not a severe form of SLE and usually disappears between 6-8 months of age, with no recurrence. And, while this decision is one that requires great care and planning, this all the more true for someone suffering with SLE. Clinicians recommend that you've been symptom-free, or in remission from lupus, for at least six months, since getting pregnant during a flare-up of lupus can increase the risk of complications and miscarriage. She'll review the drugs you're taking to ease symptoms and make flare-ups less frequent, since you might need to stop taking some that can be harmful to your pregnancy. In fact, well-controlled lupus doesn't affect fertility at all (although some lupus drugs may lower fertility, so make sure to check with your doctor if you're thinking about trying to conceive). This means you'll likely be assigned to a specialist who is familiar with high-risk pregnancies, and you'll receive some extra tests at every visit. She'll check on the status of your disease, review your medication list and help you find the right doctor to treat you during your pregnancy.
For some women, this might mean avoiding heavy exercise and sun, which are known to worsen lupus symptoms.


In fact, a 2015 study of women who became pregnant while their lupus was under control found that most had healthy, uncomplicated pregnancies as long as they didn't experience certain risk factors. Make sure to go to all your appointments (even though it can be hard with a newborn!) and keep an eye out for flare-up symptoms just as you did during pregnancy. Regular check-ins with your health care providers ensures you have the opportunity to let them know if anything seems off, and for them to check that you and your baby are healthy and aren't experiencing any complications.
The healthier you are at the time of conception, the better chances for a healthy pregnancy, delivery, and baby.
If you become pregnant unexpectedly and have lupus, please visit your rheumatologist and make an appointment with an obstetrician immediately, to assess your level of health and obtain any necessary blood tests.
If a heart block or heart disease is present, your physician may prescribe steroids to you during pregnancy to increase the chances for a positive outcome for the baby. If you are a lupus patient and want to become pregnant, planning at least six months out before conception will give you and your baby the best chances of success. If you have a Story of Hope to share about your journey to motherhood with lupus, please do so by clicking here. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns. You'll also have to visit the doctor more often: Most lupus patients check in with their practitioners every two to four weeks throughout pregnancy.
If you have particularly high levels of lupus-related antibodies in your blood or have lost a previous pregnancy, for example, daily doses of aspirin and heparin may be prescribed. These included having active lupus disease, high blood pressure requiring medication, low platelet counts and a positive lupus anticoagulant test result during the first trimester. Most importantly, take care yourself — which, like any other pregnant woman, means giving yourself permission to rest if you feel tired. This being said lupus flares can occur during pregnancy or even immediately following delivery.
This can help you and your physicians determine the best time for conception, make sure that your lupus is under control and you are at your optimum health, as well as allow you proper time to discontinue use of any medications that could be harmful to your unborn child. While there is no cure for lupus, health care practitioners now say that most lupus patients can safely get pregnant and carry a baby to term if they take a few extra steps to keep the disease under control.



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