Lupus and pregnancy
Lupus, also called systemic lupus erythematosus or SLE, is an autoimmune disorder that can cause health problems during pregnancy. Autoimmune disorders are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue just about anywhere in the body by mistake.
Lupus and other autoimmune disorders can cause swelling, pain and sometimes organ damage. Lupus also can affect joints, skin, kidneys, lungs and blood vessels.
Lupus affects more than 160,000 people in this country. Women are more likely to have autoimmune disorders like lupus than men. It often develops in women of childbearing age (16 to 44) and can affect a pregnancy. Fortunately, with the right care, you can still have a healthy pregnancy if you have lupus.
What causes lupus?
We’re not sure what causes lupus. Your genes may play role, along with other things, like viruses. Genes are the part of your cells that stores instructions for the way your body grows and works.
What are the symptoms of lupus?
Symptoms often include:
- Swollen or painful joints
- Muscle pain
- Skin rash – A red, butterfly-shaped rash across the nose and cheeks is common.
- Chest pain when taking a deep breath
The symptoms can be mild to severe with periods of remission (few or no symptoms) and flares (many or intense symptoms).
What problems can lupus cause during your pregnancy?
Lupus may increase the risk of these problems during pregnancy:
- Lupus flares. You may experience flares during pregnancy or in the first few months after giving birth. If your lupus is in remission or under good control, you’re less likely to have flares.
- Preeclampsia. Preeclampsia is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Some of these signs include having protein in the urine, changes in vision and severe headache.
- Premature birth. This is birth that happens too early, before 37 weeks of pregnancy.
- Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
- Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.
If you’ve been in remission or had your condition under good control for at least 6 months before pregnancy, you’re less likely to have complications. Talk with your health care provider before getting pregnant about the safest time for pregnancy.
What problems can lupus cause in your baby?
Most babies of mothers with lupus are healthy. However, some babies may face health risks, like:
- Premature birth. About 3 in 10 babies (30 percent) of mothers with lupus are born prematurely. Premature babies may need to stay in the hospital longer or have more health problems than babies born full term (39 to 41 weeks of pregnancy).
- Neonatal lupus. About 3 in 100 babies (3 percent) are born with this temporary form of lupus. This condition causes a rash and blood problems but usually clear up by 6 months of age. However, up to half of these babies have a heart problem called heart block. This is a condition that causes a slow heartbeat. Heart block is often permanent. Some babies need a pacemaker to help make their heart beat regularly.
How do you know if you have lupus?
If you’re experiencing the symptoms of lupus, talk to your provider. To find out if you have lupus, your provider looks at your symptoms, your health history and the results of some tests, including:
- A physical exam
- Blood tests to look for certain antibodies that often are seen in people with lupus
- Urine tests to see how well your kidneys are working
- A biopsy, testing a small sample of tissue, skin or kidneys to check for inflammation and damage
How is lupus treated?
Lupus can be treated with many different medicines. If you’re being treated for lupus, talk to your provider about the medicines you’re taking before you get pregnant. Your provider may want to change your medicine while you’re pregnant.
Medicines used to treat lupus include:
- Anti-inflammatories. Aspirin, ibuprofen (Motrine® or Advil®) and naproxen (Aleve®) can help relieve joint pain and fever. Talk to your provider to find out if you can take these during pregnancy.
- Malaria medicines. Hydoxychloroquine (Plaquenil®) and other malaria medicines can help prevent flares and relieve joint pain, tiredness and other symptoms. These medicines are safe to use during pregnancy.
- Corticosteroids. Prednisone (Sterapred®), methylprednisolone (Medtrol®) and related medicines can help reduce inflammation and relieve symptoms. These medicines can only be used for a short time because of side effects. They are fairly safe to use during pregnancy, but they may increase the risk of cleft palate. This is a birth defect in which the roof of a baby’s mouth doesn’t form completely and has an opening in it.
- Immunosuppressives. Cyclophosphamide (Cytoxan®) and methotrexate (Folex®, Mexate®, Rheumatrex®) are cancer-fighting medicines. Azathioprine (Imuran®) and mycophenolate mofetil (CellCept®) are medicines used in organ transplant patients to help prevent organ rejection. Your provider may treat you with immunosuppressive medicines if you have serious lupus symptoms. These medicines may cause serious side effects, such as increased risk of serious infection. They’re not safe take if you’re pregnant. Both cyclophosphamide and methotrexate are associated with birth defects. We don’t know how safe azathioprine and mycophenolate mofetil are during pregnancy.
Do you need special medical care during pregnancy?
Yes. Your provider closely monitors your pregnancy so that any lupus flares or problems can be treated quickly. In general, you should be cared for by:
- High-risk obstetrician, a doctor who specializes in taking care of women with serious pregnancy complications
- Rheumatologist, a doctor who specializes in disorders having to do with inflammation or pain in muscles and joints
Most likely your baby will be born healthy, but you may want to plan to give birth in a hospital that is equipped to care for premature or sick babies.
For more information:
Last reviewed December 2011
Frequently Asked Questions
What is mononucleosis?
Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.
You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:
- Achy muscles
- Belly pain
- Fatigue (feeling tired all the time)
- Sore throat
- Swollen glands in your neck
If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.
There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.
Can Rh factor affect my baby?
The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.
If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.
If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.
I had a miscarriage. How long should I wait to try again?
Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.
Are gallstones common during pregnancy?
Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.