- 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.
- Pregnancy
is advised against during flares as well as when
major organ involvment is present.
- Women
conceiving after 5 or 6 months of remission are
much less likely to experience lupus flares
during her pregnancy than are those women who get
pregnant while their lupus is active.
- Lupus
nephritis before conception also increases the
chance of experiencing a lupus flare during
pregnancy.
- Women
in remission have much less trouble than do women
with active disease and their babies do much
better as well.
- It
is important to note that although many lupus
pregnancies will be completely normal, all
lupus pregnancies should be considered high-risk.
- High-risk
is a term commonly used by obstetricians to
indicate that solvable problems may occur and
should be anticipated.
 Pregnant
lupus patients should be managed by obstetricians
who are thoroughly familiar with high risk
pregnancies and who work in close concert with
the woman's primary physician.
- During
pregnancy, flares most often occur during the
first or second trimester, or during the two
months immediately after delivery during the
postnatal period.
- The
most common symptoms of flares during pregnancy
are arthritis, rashes, and fatigue.
- It
is important to distinguish the symptoms of a
lupus flare from the normal body changes that
occur during pregnancy.
- Frequent
doctor visits are important in any high risk
pregnancy because many conditions
 which may
occur can be prevented or treated more easily
when found early.
- Prednisone
does not get through the placenta and is safe for
the baby.
- Specifically
because dexamethasone and betamethasone do reach
the baby, they are used only when it is necessary
to treat the baby as well.
Aspirin is safe and it is most
often used to protect against a complication
known as toxemia of pregnancy or what is also
known as pre-eclampsia which
involves hypertension with fluid retention and is
monitored closely and treated accordingly,
including bed-rest and possible early
hospitalization to ensure that a term delivery
and a healthy baby ensues even if by C-section if
necessary.
 Cyclophosphamide-(Cytoxan)
is definitely harmful if taken during the first
three months of pregnancy. - A
few doctors feel that all pregnant women with
lupus should take small doses of Prednisone to
prevent early abortion.
- Similarly,
some physicians feel steroids should be given or
increased after the baby is born to prevent
post-partum flare.
- Antibodies
that interfere with the function of the placenta
are called antiphospholidid antibodies, or
the lupus anticoagulant.
- Recurrent
pregnancy loss is now considered a treatable
clinical condition associated with
antiphospholipid antibodies. The management of
pregnant patients with antiphospholipid syndrome
is rightly based on the use of
antiaggregant/anticoagulant agents (with aspirin
and heparin) to prevent thrombosis in the
uteroplacental circulation. Interventions with
these drug therapies and monitored pregnancy have
increased fetal survival.
- These
antibodies can occur during the second trimester,
slowing the baby's growth.
Aspirin, Prednisone, Heparin, and
Plasmapheresis have all been suggested as safe,
possible therapies for Anti-Phospholipid
or Hughes
Syndrome.
About 3% 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 3-6 months
old and does not recur. 
About one-half of babies with neonatal lupus are
born with
a heart condition. This condition is permanent,
but it can be treated with a pacemaker
Currently Pregnancy is considered
to be successful with the Lupus patient accepting
of the appropriate medical care professionals and
any necessary interventions throughout her terms
to ensure safety
of both the mother and child.
Caring for Yourself Throughout the
Pregnancy:
- Keep all of your appointments with your primary
doctor and your obstetrician.
- 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
continue others.
- Don't smoke, and don't drink alcoholic beverages.
- 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.
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