Lupus and Pregnancy

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Category: Systemic Lupus Erythematous Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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Daytona Beach News Journal

Are you of childbearing years and have lupus? Are you concerned about the effects of your disease with pregnancy or oral contraceptives?

Like many young women with lupus, Allison, a twenty-six year old teacher, was worried that oral contraceptives would aggravate her lupus and if becoming pregnant would be safe for her and her unborn baby.

ORAL CONTRACEPTIVES:

Even though hundreds of women with lupus take birth control pills without difficulty, those with or without lupus and with anti-phospholipid antibodies, high blood pressure, migraines, a history of abnormal blood clotting, or very high lipids, should not take them because of an increased risk of blood clots or stroke. Fortunately, there is no evidence that oral contraceptives increase a genetically susceptible women’s risk of developing lupus.

FERTILITY AND PREGNANCY:

Normally, lupus does not affect a women’s fertility and the majority can have healthy babies, with only a small amount of risk. However, several specific circumstances, such as disease activity and drug treatments like Cytoxan can cause complications such as infertility and fetal malformation. 

DIFFERENT RISK LEVELS:

Women with mild or inactive lupus, off all medication, and lacking the Ro (SSA) and anti-phospholipid antibodies, have the same 5 to 10% risks during pregnancy as the general population: pretty much nothing to worry about.

Unfortunately, pregnant women with active lupus myocarditis, lupus nephritis with elevated serum creatinine, severe and uncontrolled high blood pressure, and those who need to receive Cytoxan during their pregnancy, face an extremely high risk of prematurity, miscarriage, stillbirth and of maternal organ failure.

Consequently, women with active lupus should postpone becoming pregnant until her lupus is well controlled.

THE EFFECTS OF AUTOANTIBODIES:

Lupus, an autoimmune disease, produces different types of autoantibodies that can affect different parts of the body. Especially important during pregnancy are the anti-phospholipid, anti-Ro (SSA) and anti-La (SSB) antibodies.

One third of women with lupus carry the anti-phospholipid antibody, which can cross the placenta and promote blood clots, increasing the risk of miscarriage to 20 to 50%. Also, 20 to 30% of women with SLE carry the anti-Ro (anti-SSA) and anti-La (anti-SSB) antibodies, which can create a small risk (2%) of inducing neonatal lupus, a self-limited and mild process that disappears within weeks to months, or congenital heart block (5 %), which calls for a fetal echocardiogram between weeks 18 to 24. Therefore, it is recommended to have anti-phospholipid, anti-Ro and anti-La antibodies levels checked before pregnancy. 

MEDICATIONS DURING PREGNANCY:

Regular aspirin, NSAIDs on a long –term basis and anti-malaria drugs are not advisable during pregnancy. Cytoxan and MTX should be avoided unless the life of the mother is at stake, due to the increased risk of fetal deformity.

Even though the rule of thumb is to avoid medication during pregnancy, Prednisone and Imuran seem to be safe and effective if necessary. With the guidance your doctor, you can have the family you’ve always dreamed of.

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