15 Tips on Having a Successful Pregnancy with Lupus
For those of you have been following my blog for awhile now, you know I’ve shared my experiences of being pregnant while having lupus (here’s just one). Staying healthy during pregnancy while keeping lupus symptoms at bay remains a hot topic that a lot of women with lupus are concerned about.
The following article was written specifically for Lupine Life by Dr. Donald Thomas. He is an award-winning rheumatologist in Greenbelt, Maryland; some of his most recent awards include Top Doctors, Patient’s Choice Award, and Top Physician in Rheumatology.
Dr. Thomas is also the author of a forthcoming book: The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families. Subscribe to my blog and follow me on Twitter so you don’t miss my upcoming review of his book. (Click on the buttons to the right.)
TIPS ON HAVING A SUCCESSFUL PREGNANCY WITH LUPUS:
1980s: Rheumatologist discussion about pregnancy to lupus patient: “Do not become pregnant, it is too dangerous.”
Today: Dr. Michelle Petri (Co-Director of Johns Hopkins Lupus Pregnancy Center) has stated recently, “For most women with lupus, a successful pregnancy is possible … For nearly all mothers, a happy outcome is possible.” What a huge difference compared to just a few decades ago!
It is a travesty that systemic lupus most commonly affects women during their childbearing years. During most of the 20th century, this has prevented many women with lupus from being able to have children. Fortunately, today things are very different. The vast majority of women who have systemic lupus erythematosus can and do have children. However, it does take appropriate planning in order to do so. I will outline some of the most important steps below.
- Plan your pregnancy. Do not become pregnant by accident. You want to wait until your lupus has been under control for 6 months before becoming pregnant. If you do so, the studies show that your chances of having a normal outcome are close to that of women who do not have lupus. Make sure to consult your rheumatologist regarding the proper time to get pregnant.
- Some medications used to treat lupus must be stopped before even trying to become pregnant. Methotrexate must be stopped 3 months before trying to conceive, CellCept for 6 weeks, cyclophosphamide for 3 months, Benlysta for 4 months, bisphosphonates (such as Fosamax) for 6 months, and Rituxan for 1 year.
- Once you are pregnant, I like to see my patients monthly to ensure their lupus stays under control during pregnancy and that they are followed by a high-risk obstetrician. Discuss this possibility with your rheumatologist.
- Keep taking your hydroxychloroquine (Plaquenil) as it is not associated with any fetal problems. The chances of having a good outcome are markedly increased if you stay on your Plaquenil. One of the primary things that could hurt you or your baby during pregnancy is for your lupus to become active due to unnecessarily stopping your Plaquenil.
- If you are on medicines that are unsafe to take during pregnancy (e.g. CellCept, methotrexate, Arava, etc.), ask your rheumatologist if it should be changed to a medication that is considered safe to take during pregnancy such as Imuran (azathioprine).
- Find out if you are positive for SSA or SSB antibodies from your rheumatologist. If you are, then you have about a 2% chance (rare) of your baby developing fetal heart block (a rhythm problem of the heart). Make sure to see a high-risk obstetrician and start having fetal heart monitoring on a weekly basis beginning the 16th – 18th week of pregnancy. Of note, taking hydroxychloroquine (Plaquenil) during pregnancy decreases this risk.
- Find out if you are positive for antiphospholipid antibodies (ask your rheumatologist to check them). If they are positive, then ask if you should be taking low-dose aspirin or other blood thinners daily to prevent a miscarriage. Make sure to stop aspirin during the third trimester in order to prevent circulation problems in the baby.
- Stop nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, Motrin, Naprosyn, etc. during the third trimester to prevent circulation problems in the newborn.
- Do not smoke cigarettes nor drink alcohol. Both increase your risk of losing your baby or of the baby developing organ damage problems.
- Exercise regularly and eat a healthy diet during pregnancy (get specific recommendations from your obstetrician).
- Take supplements as recommended by your obstetrician (prenatal vitamins, folic acid, etc.).
- If you have any major organ involvement from your lupus (e.g., heart, lung, liver, kidney, etc.), make sure to see that particular specialist (e.g., nephrologist for the kidneys) throughout your pregnancy.
- If you are on thyroid supplementation, have your thyroid tests checked regularly during pregnancy. Abnormal thyroid studies increase the risk of a bad outcome from pregnancy.
- If you have been on steroids for a significant amount of time and are at risk of adrenal insufficiency (ask your rheumatologist), let your obstetrician know to give you extra “stress doses” of steroids at the time of delivery.
- Ask your rheumatologist to either give you a steroid shot in the buttock muscle, or to take some extra steroids by mouth 10 – 14 days after delivery to prophylactically prevent a flare of lupus (not uncommonly occurs after delivery around this time period).
Something to keep in mind: approximately 15% of pregnancies in “normal” women end in miscarriage. Studies suggest that if someone with systemic lupus abides by all of the above recommendations, her chances of having a successful birth are close to normal. In caring for patients with SLE during the past 20 years, I have my patients abide by these rules, and so far all of my patients have had success. It takes a lot of extra work, but the results, of course, are well worth it.
I wish the best to all the hopeful women with lupus who are reading this article, and I hope you have a successful pregnancy.
By Donald Thomas, MD
Author of “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families”