Lupus and Pregnancy: Is It Safe?

A lupus diagnosis comes with a lot of questions. And because lupus usually emerges during the reproductive years, questions about getting pregnant are high on that list.

“It can be safe to get pregnant with lupus, but there is a higher risk of complications for both the mother and the developing baby,” says rheumatologist Sukanya Pachaidee, MD. “It’s important to take it seriously and plan ahead for a safe pregnancy.”

Risks to pregnancy with lupus

Lupus is an autoimmune condition where your immune system attacks healthy tissue. This can lead to problems in many parts of your body, including your skin, joints, kidneys, lungs, blood and heart.

What lupus does not affect is fertility — a woman with lupus is just as likely to get pregnant as one without. But pregnancies in women with active lupus are considered high risk.

That doesn’t mean every woman with lupus will experience pregnancy complications. But there is a higher chance of problems — especially in women whose lupus symptoms aren’t under control.

“The prognosis for both mother and child is best when systemic lupus erythematosus has been quiescent for at least six months prior to pregnancy,” Dr. Pachaidee says.

Pregnancy complications are more likely in women who have:

• Kidney disease.
• High blood pressure.
• A history of blood clots.
• A history of low platelets.

Risks to the mother

Women with lupus are at increased risk of maternal health problems, including:

• Lupus flares.
• Impaired kidney function.
• Preeclampsia and HELLP syndrome, a complication affecting the liver and blood.

Risks to the baby

Lupus can also increase the risks to the developing baby, such as:

• Slowed fetal growth.
• Miscarriage or stillbirth.
• Premature birth.
• Neonatal lupus, a rare condition in which antibodies from the mother can cause a rash or, in some cases, a heart block in the fetus.

While this all sounds scary, remember that many women with lupus have completely smooth, healthy pregnancies. But it’s helpful to understand the risks, so you and your doctors can take steps to minimize them.

Planning ahead for a lupus pregnancy

When you have lupus, consult with your ob/gyn to use birth control (IUD is the preferred choice) to prevent an accidental pregnancy, Dr. Pachaidee advises. If you decide you’re ready to try for a baby, talk to your doctor to make sure it’s safe before you stop your birth control.

If you’re in remission when you get pregnant, you’re less likely to experience pregnancy complications. So work closely with your doctor to be in the best health you can be before you start trying for a baby, Dr. Pachaidee says. “When you have active disease, you are at greater risk.”

Some lupus medications are safe to use during pregnancy, but others are not. That’s another good reason to plan ahead. “Medications that keep you in remission are generally safe to take during pregnancy. If you are taking medications that aren’t safe during pregnancy, your doctor can help you find alternatives before you get pregnant,” she says.

Lupus during pregnancy: A team effort

Once you’re pregnant, you’ll need regular check-ups to make sure you’re staying healthy. “Managing your pregnancy should be a team effort involving you, your Ob/Gyn and your rheumatologist,” Dr. Pachaidee says.

Your team will do regular tests to look at your blood chemistry and organ function. They’ll also look for the presence of different types of antibodies that can cause trouble during pregnancy. These are:

• Antiphospholipid antibodies can interfere with the placenta and slow fetal growth.
• Anti-SSA/Ro and anti-SSB/La antibodies can cause neonatal lupus in the newborn.

If your doctor detects these antibodies or other problems, they’ll monitor the pregnancy more closely to watch for complications.

Managing lupus during pregnancy

During your pregnancy, it’s important to stay as healthy as you can, Dr. Pachaidee says. “I recommend all patients keep their immune systems happy. Focus on good sleep, exercise and eating the right foods.”

Unfortunately, lupus can flare up during pregnancy or after childbirth — even if you’ve been in remission for a while. If you notice symptoms starting, talk to your doctor as soon as possible, Dr. Pachaidee says. “There are safe medications you can take to reduce flares during pregnancy.”

What about breastfeeding?

Can you breastfeed with lupus? For most women, the answer is yes. “But you will need to avoid certain medications while breastfeeding because they can pass into breast milk and harm a baby,” she says. “If you need those medications to control lupus after the baby is born, you might need to stop breastfeeding.”

A healthy pregnancy with lupus takes a little extra planning, but many women with the condition have given birth to healthy babies. “Lupus is not something you can take lightly,” Dr. Pachaidee says. “But a safe pregnancy is possible.”