Pregnancy and Lupus
Twenty years ago, medical textbooks
said that women with lupus should
not get pregnant because of the risks
to both the mother and unborn child.
Today, most women with lupus can
safely become pregnant. With proper
medical care, you can decrease the risks
associated with pregnancy and deliver a
normal, healthy baby.
To increase the chances of a happy
outcome, however, you must carefully
plan your pregnancy. Your disease
should be under control or in remission
before conception takes place. Getting
pregnant when your disease is active
could result in a miscarriage, a
stillbirth, or serious complications for
you. It is extremely important that
your pregnancy be monitored by an
obstetrician who is experienced in
managing high-risk pregnancies and
who can work closely with your primary
doctor. Delivery should be planned at
a hospital that can manage a high-risk
patient and provide the specialized
care you and your baby will need. Be
aware that a vaginal birth may not be
possible. Very premature babies, babies
showing signs of stress, and babies of
mothers who are very ill will probably
be delivered by cesarean section.
One problem that can affect a pregnant
woman is the development of a lupus
flare. In general, flares are not caused
by pregnancy. Flares that do develop
often occur during the first or second
trimester or during the first few months
following delivery. Most flares are mild
and easily treated with small doses of
Another complication is pregnancyinduced
hypertension. If you develop
this serious condition, you will
experience a sudden increase in blood
pressure, protein in the urine, or both.
is a serious condition that requires
immediate treatment, usually including
delivery of the infant.
The most important question asked by
pregnant women with lupus is, "Will
my baby be okay?" In most cases, the
answer is yes. Babies born to women
with lupus have no greater chance of
birth defects or mental retardation than
do babies born to women without lupus.
As your pregnancy progresses, the doctor
will regularly check the baby's heartbeat
and growth with sonograms. About 10
percent of lupus pregnancies end in
unexpected miscarriages or stillbirths.
Another 30 percent may result in
premature birth of the infant. Although
prematurity presents a danger to the
baby, most problems can be successfully
treated in a hospital that specializes in
caring for premature newborns.
Caring for Yourself
- Keep all of your appointments
with your primary doctor and
- Get enough rest. Plan for a
good night's sleep and rest
periods throughout the day.
- Eat a sensible, well-balanced
diet. Avoid excessive weight
gain. Have your obstetrician
refer you to a registered
dietitian if necessary.
- Take your medications as
prescribed. Your doctor
may have you stop some
medications and start or
- Don't smoke, and don't drink
- Be sure your doctor or nurse
reviews with you the normal
body changes that occur during
pregnancy. Some of these
changes may be similar to
those that occur with a lupus
flare. Although it is up to the
doctor to determine whether
the changes are normal or
represent the development of a
flare, you must be familiar with
them so that you can report
them as soon as they occur.
- If you are not sure about a
problem or begin to notice a
change in the way you feel, talk
to your doctor right away.
- Ask your doctor or nurse
about participating in childbirth
preparation and parenting
classes. Although you have
lupus, you have the same needs
as any other new mother-to-be.
About 3 percent of babies born to
mothers with lupus will have neonatal
lupus. This lupus consists of a temporary
rash and abnormal blood counts.
Neonatal lupus usually disappears by the
time the infant is 3 to 6 months old and
does not recur. About one-half of babies
with neonatal lupus are born with a
heart condition called heart block. This
condition is permanent, but it can be
treated with a pacemaker.
Planning Your Pregnancy
You and your spouse or partner should
talk to your doctor about the possibility
of pregnancy. You and the doctor should
be satisfied that your lupus condition
is under good control or in remission.
Your doctor should also review potential
problems or complications that could
arise during the pregnancy, their
treatment, and outcomes for both you
and the unborn child.
You should select an obstetrician who
has experience in managing high-risk
pregnancies. Additional experience in
managing women with lupus is also good.
The obstetrician should be associated
with a hospital that specializes in highrisk
deliveries and has the facilities to
care for newborns with special needs.
It is a good idea to meet with the
obstetrician before you become pregnant
so that he or she has an opportunity to
evaluate your overall condition before
conception. This meeting also will give
you the opportunity to decide if this
obstetrician is right for you.
Check your health insurance plan. Make
sure that it covers your health care needs
and those of the baby and any problems
that may arise.
Review your work and activities schedule.
Be prepared to make changes if you are
not feeling well or need more rest.
Consider your financial status. If you
work outside the home, your pregnancy
and motherhood could affect your ability
Develop a plan for help at home during
the pregnancy and after the baby is born.
Motherhood can be overwhelming and
tiring, and even more so for a woman
with lupus. Although most women with
lupus do well, some may become ill and
find it difficult to care for their child.
After The Baby Is Born
Be sure your doctor or nurse reviews
with you the physical and emotional
changes that occur as your body returns
to normal. These changes are the same as
those experienced by women who do not
(The Postpartum Period)
Be aware that postpartum complications
can arise. In addition to those that any
woman who has been pregnant can
experience, you might develop a lupus
Try to breastfeed your baby. It is the
ideal, low-cost way to provide nutrition
for your baby in the first weeks or
months of life. It takes time for mothers
and babies to learn how to breastfeed and
it may take a few weeks to get adjusted.
Because breastfeeding can sometimes be
a challenge, ask your doctor or nurse for
help so you do not become discouraged.
Sometimes, though, breastfeeding may
not be possible for the following reasons:
Be confident, though, that whichever
method you choose to use to feed your
baby, it will be the right decision for
- A premature baby may not be able
to suck adequately. Feeding your
baby through a tube at first and
then by bottle may be necessary.
However, you may still be able to
pump your breast milk for your
- If you are taking corticosteroids,
you may not be able to produce
- Some medications can pass
through your breast milk to your
infant. It will be up to your doctor
to decide whether breastfeeding is
safe if you are taking any of these
- Because breastfed infants tend
to eat more frequently than do
bottle-fed infants, breastfeeding
can be very tiring. You may want
to switch to a bottle and formula if
breastfeeding becomes too tiring.
Before you leave the hospital, discuss
birth control options with your doctor.
Because it would be unwise for you
to become pregnant again soon after
giving birth, be sure to use an effective
birth control method. REMEMBER: You
can get pregnant before your period
begins again; also, breastfeeding
and withdrawal of the penis before
ejaculation are not effective birth control
Source: National Institutes of Health, U.S.Dept of Health and Human Services