27.02.2015

Planning a 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. Lupus has important implications for the lifestyle and quality of life of the woman who has it. A: Lupus flares could happen even after a long remission, during pregnancy, or in the 2 months after delivery, but are usually mild-joint pain, rashes, fatigue. First time pregnant women with lupus may experience, in the second half of pregnancy, preclampsia which is hypertension with protein in the urine, that mimics lupus nephritis. A: It is best not to breastfeed if the mother needs medications for lupus, except for small doses of prednisone, up to 15-20 mg per day.
In closing, I would like to emphasize that lupus pregnancies are more successful than ever before, with the advances in SLE treatment by rheumatologists, aggressive follow-up and early diagnosis of fetal distress by obstetricians, and superior treatment by neonatologists, with increased survival of premature babies. However, for women with lupus, they may feel that it is a dream which can never be achieved.
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.
A good general rule is, to be free of lupus activity, in a remission, for 6 months or more. A progesterone implant is a small tube with progesterone that is placed under the skin and can prevent pregnancy for up to 5 years. Though some of them may insist to plan for a pregnancy, they are circled with doubts and questions if the newborn baby will be healthy.


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. There is a slight risk of unwanted pregnancy with IUD and some potential side effects: bleeding and infection.
Laboratory tests can help: complement is low and anti-DNA is high in lupus flare, and there may be other systems involved by the flare. Three such antibodies are usually tested for in the blood, anticardiolipins, lupus anticoagulant, and false positive VDRL. 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.
A flare, especially a severe one, is a very difficult time for the non-pregnant patient with lupus. Barrier methods of contraception include the diaphragm with spermicide, and condom with spermicide. This is especially important if you are experiencing frequent flare-ups as your doctor can advise you if this is the right time to plan for a pregnancy. New involvement with nephritis can occur during pregnancy, and sometimes be mistaken for pregnancy-induced hypertension or preeclampsia. Hydroxychloroquine (Plaquenil) and azathioprine (Imuran) are well tolerated with little or no risk for fetal malformations. In fact, some doctors believed that pregnancy should not be attempted until the symptoms of lupus have been controlled or in a remission stage for at least several months to a year.If pregnancy is not advised or for whatever reason you do not wish to become pregnant, the only way to make sure that you do not conceive is to use an effective form of birth control. Not treating lupus nephritis during pregnancy can have dire consequences for mother and baby, such as loss of kidney function, loss of the baby. Contraceptives available to women with lupus are the same as for other women, but with one noticeable exception. However, a severe nephritis flare during pregnancy may require intravenous Cytoxan, if the kidney function is being compromised.
Women with lupus should not use birth control pills, unless your doctor has specifically approved their use for you. Low birth weight of the baby from malnutrition in the uterus, and even miscarriage (fetal death), usually in the second half of the pregnancy. The risk of unplanned pregnancies with any of these birth control options is reduced as long as the techniques are used correctly.
Baby aspirin is effective in the prevention of low birth weight and some miscarriages, while recurrent aborters do better with heparin treatment.
Talk with your doctor to find out which method will work best for you.Certain immune-suppressive drugs should also be discontinued prior to conception. In some cases of lupus, menstruation may cease or periods become irregular when they used to be regular.However, doctors have indicated that even if menstruation ceases, ovulation can still take place and contraception can still occur.
So if you are not menstruating, that does not mean you cannot become pregnant.When you and your partner decide to try for contraception, check with your doctor to make sure that there are no other reasons to hold off.
So the best is to have an open discussion with your doctor since each case is very individual.
Although you may have had an obstetrician before you were diagnosed with lupus, be sure that he or she will take care of you now, considering your condition.


Some may prefer not to take individuals with lupus and may suggest you switching to a different obstetrician.
Typically, women with lupus have a statistically greater chance of premature births and neonatal complications.
Pregnancy problems may also be due to hypertension, gestational diabetes and lupus activity. Or you may experience more marked symptoms and be in a flare for almost the whole time.As a matter of fact, some people first learn that they have lupus during or after their pregnancy.
This is because symptoms develop which prompt them to go to the doctor and that is when they discover that they have lupus.
In more than half of women with lupus, pregnancy has no bearing at all on the way lupus affect them. For the most part, be reassured that even if pregnancy does affect your lupus, either during or after the pregnancy, these problems are rarely serious to the extent of life-threatening. Medication And PregnancyIf possible, it is usually a good idea to avoid most medication during pregnancy. Many women, for example have used aspirin during their pregnancies without any damage to the fetus.
However, do not take decisions lightly with regards to medications and pregnancy by discussing whatever thoughts you might have with the doctor.There are certain medications that should not even be considered during pregnancy, such as immuo-suppressive drugs.
Your doctor will determine specifically what your nutritional and weight goals are, depending on your size, pre-pregnancy weight, ideal weight and other factors.During pregnancy, you will probably need to increase your intake of protein as well as iron, folic acid and calcium.
As such, discuss and devise a nutritional plan with your doctor, nurse or dietitian so that you and your baby will stay healthy.Exercise During PregnancyExercise during pregnancy is now just as important as before you get conceived. The benefits from regular exercising such as relaxation, better fitness, better body image, increased sense of well-being are necessary during pregnancy.Therefore, do not stop exercising but you can lower the intensity of your workout. Being physically fit and staying that way will help you to deal better with labor and childbirth.
Increased lupus problems often relate to kidney problems or emotional distress, although flares can occur for any reason. However, close cooperation with your doctor can probably reduce the likelihood of such a postpartum flare or at least of such a flare become serious.Generally, the babies of mothers with lupus do not show any more evidence of lupus at birth than the babies delivered by women who do not have lupus. However, newborns of mothers who have lupus may show a higher incidence of congenital heart block.
This medical problem is usually associated with the presence in the mother of one of the anti-nuclear antibodies, called anti-Ro.Therefore, experts feel it would be reasonable to check all newborns of mothers with lupus for this problem, so that appropriate treatment can be started if necessary. But the results are most likely positive because the mother’s blood has been circulating within the baby. The tests no longer usually show a positive result after the baby is a few months old.The period of time following childbirth can be tiring for any mother especially when lupus adds more potential stress to the mix. For example, doctors say that breastfeeding causes the uterus to return to its pre-pregnant state faster.Breast milk is an ideal food for your bay as it is packed with nutrients, and it contains some of your own antibodies, which will help your baby to fight off illness. However, do take note that if you have more than just a mild case of lupus, or if you have been on moderate dosages of steroids for prolonged periods of time, do consult with your doctor regarding breastfeeding. This is because the medication may get into the milk that may affect the baby.If you and your partner are planning a pregnancy with existing lupus condition, bring all of the issues that concern you openly during the discussion with your family, obstetrician and rheumatologist.
Besides, any concerns or potential risks of pregnancy should be taken into serious consideration. Typically, pregnancy should not be a problem at all especially if you have only a mild case of lupus.



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Comments to «Planning a pregnancy with lupus»

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