- 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, generally speaking.
- 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 as well as the
women themselves.
- 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 any changes in the way
you feel, speak 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.
|
+