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Systemic Lupus Erythematosus and Pregnancy

Systemic lupus erythematosus, a condition that is often simply referred to as “lupus,” affects many systems of the body. It occurs in one of every 700 people and is more likely to affect black women and women of childbearing age. Pregnancy does not affect the incidence of lupus.

Symptoms of lupus

Lupus is a chronic disease with periods of active disease called “flares,” followed by periods of remission. The main symptom is joint pain. Other symptoms may include mouth ulcers, fever, skin rash, kidney problems, and high blood pressure. Lupus is sometimes difficult to diagnose because the symptoms are vague and vary from person to person. A person may be classified with lupus if she meets four of the following criteria:

  • a butterfly-shaped rash on the cheeks or circular, red areas of skin
  • ulcers in the mouth
  • sun sensitivity
  • arthritis in two or more joints
  • an inflammation of the lungs called pleurisy or an inflammation of the heart called pericarditis
  • seizures, psychosis, or other neurological conditions
  • kidney problems
  • blood disorders
  • immunological disorders as diagnosed through blood tests
  • presence of antinuclear antibody in the blood

Effects of lupus on the pregnant mother

Lupus does not affect the ability to become pregnant, and most women with lupus can have a successful pregnancy. During pregnancy, some women find that their flares get worse, and some find that they improve.

If you have lupus with kidney involvement, there is an increased chance of high blood pressure during pregnancy and a small chance that pregnancy will cause permanent damage to the kidneys.

Effects of lupus on the unborn baby

Pregnant women with lupus are considered high-risk. The risks of pregnancy loss (miscarriage/spontaneous abortion) or premature birth are increased in women who have lupus.

One condition of concern in pregnant women with lupus is the possibility of the baby developing a heart condition called congenital heart block. Congenital heart block causes the baby’s heart to beat about 40 to 60 times per minute instead of the normal 110 to 160 times per minute. If the unborn baby is diagnosed with congenital heart block, there may be other heart defects. Therefore, the unborn baby will need a kind of heart ultrasound, called a fetal echocardiogram, to check for these abnormalities. The baby will also be monitored by ultrasound every one or two weeks.

There is also an increased risk that the unborn baby may develop a swelling called hydrops. This is a sign that the baby may be having congestive heart failure. If this happens, you and the unborn baby will need to monitored in hospital and the baby may need to be delivered prematurely. Your risk of having a baby with heart problems is greater if you are producing certain types of antibodies.

Treatment of lupus in pregnancy

Although lupus is considered high-risk in pregnancy, careful monitoring by your obstetrician, in conjunction with a rheumatologist, should result in a safe pregnancy and a healthy baby.

Ideally, you should consult your doctor before you start trying to become pregnant. The timing of conception is important and pregnancy usually goes more smoothly if conception occurs during a long remission. Before you become pregnant, you should be tested for certain antibodies and a 24-hour urine test will be required. Your doctor will discuss the results with you and determine what impact they might have on your pregnancy. You should also discuss the medications you are taking. You may need to take new medications during pregnancy.

You should have an ultrasound within the first 12 weeks of pregnancy, or as soon as possible if you find out you are pregnant after 12 weeks gestation. More ultrasounds can be held every four to six weeks to assess the growth of the developing baby. Your medical visits and laboratory tests will be more frequent than the average pregnant woman. You may need more 24-hour urine testing to monitor your kidney function. You might also need non-stress testing, where a fetal monitor is used to assess the baby’s heart rate.

Childbirth is usually normal in women with lupus, unless the baby has fetal growth restriction or the mother has high blood pressure.

For more information, see "Lupus" in our Health A-Z.

9/11/2009




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