Is pregnancy possible in lupus? The answer
is very definitely yes. As recently as ten years ago many patients
were routinely advised against pregnancy in lupus but this is now
known to be incorrect. However, it is advisable for a woman with
lupus and her partner to discuss with an obstetrician all the issues
likely to be involved in her particular case before embarking on
a pregnancy.
What are the problems?
There are two major potential problems. Firstly, an increased
risk of miscarriage in those patients with anticardiolipin antibodies
(see fact sheet on antiphospholipid (Hughes) syndrome). Secondly,
a chance of a flare of lupus after the baby is born - in the 'puerperium'.
Does the lupus get worse in pregnancy?
In the majority of cases it does not although flares occur with
almost the same frequency as in the non-pregnant state.
What if I have kidney disease?
Where there is kidney disease the success of pregnancy clearly
depends on the degree of kidney involvement. Blood pressure control
is far more difficult where kidney disease is present but it is
now recognised that lupus patients with definite mild kidney disease
can have successful pregnancies.
Recurrent miscarriages
Lupus patients should all be tested for antiphospholipid antibodies
(see antiphospholipid (Hughes) syndrome). If these tests are positive
there is an increased risk of miscarriage and patients are treated
accordingly - either with aspirin or heparin during the pregnancy.
In those patients with lupus who are anticardiolipin negative it
is probably true to say that there is not an increased risk of
spontaneous miscarriage.
Drugs and pregnancy
Drugs which are contraindicated in pregnancy include warfarin,
which can affect the foetus in the early development stage, cyclophosphamide
and methotrexate. Low dose antimalarials (plaquenil 200mg daily
for example) appear to be safe in pregnancy and can continue to
be used by those patients already on this drug. It may come as
a surprise to some that the safest medicine of all in pregnancy
is steroid (a 'hormone') and flares during pregnancy are routinely
treated by changing the steroid dosage.
Will my baby be fine?
Lupus mothers have normal babies. However, there is one congenital
problem which has been described in rare cases. Approximately 1
in 1000 babies of lupus mothers are born with a slow pulse rate,
so-called congenital heart block. This congenital abnormality is
only seen in offspring of mothers with a particular antibody anti-Ro
(see fact sheet on Lupus and Laboratory Tests).
The anti-Ro antibody may also, very rarely, give rise to a lupus-like
rash which will usually disappear in the first twelve months.
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