Since lupus primarily affects young women, pregnancy often becomes a crucial question. Years ago, all medical texts said that women with lupus could not have children, and if they became pregnant, they should have therapeutic abortions. We now know that these early conclusions were wrong. Currently, more than 50 percent of all lupus pregnancies are completely normal. Twenty-five percent of women with lupus deliver normal babies prematurely. Fetal loss, due to spontaneous abortion (miscarriage) or death of the baby, accounts for less than 20 percent. Not all of the problems of pregnancy with lupus have been solved, but pregnancies are possible, and normal children are the rule.
While it is certainly possible for women with lupus to have children, pregnancy may not be easy. 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 must be anticipated. A pregnancy in a woman with lupus should be managed by obstetricians who are thoroughly familiar with high risk pregnancies and who work closely with the woman's primary physician. Delivery should be planned at a hospital that has access to a unit specializing in the care of premature newborns. SLE mothers should not attempt home delivery, or be overly committed to "natural" childbirth, since treatable complications during delivery are frequent. However, under close observation, the risk to the mother’s health is lessened, and healthy babies can be born.
Will Pregnancy Flare My Lupus?
Although older medical texts suggest that SLE flares are common in pregnancy, recent studies indicate that flares are uncommon and are usually easily treated. In fact, some women with lupus will actually experience an improvement in disease symptoms during pregnancy. Most of the flares tend to be mild. The most common symptoms of these flares are arthritis, rashes, and fatigue. Approximately 33 percent of women with lupus will have a decrease in platelet count during pregnancy, and about 20 percent will have an increase in or new occurrence of protein in the urine. These abnormalities may be due to pregnancy rather than to lupus. These levels usually recover after delivery.
Women who conceive after five-six months of remission are less likely to experience a lupus flare than those who get pregnant while their lupus is active. The presence of lupus nephritis before conception also increases the chance of having complications during pregnancy.
It is important to distinguish the symptoms of a lupus flare from the normal body changes that occur during pregnancy. For example, because the ligaments that hold the joints together normally soften in pregnancy, fluid may accumulate in the joints (especially in the knees) and cause swelling. Although this condition suggests inflammation due to lupus, it may simply be the swelling that occurs during a normal pregnancy. Similarly, lupus rashes may appear to worsen during pregnancy, but this is usually due to increased blood flow to the skin that is common in pregnancy (the "blush" of a pregnant woman). Many women also experience new hair growth during pregnancy, followed by a dramatic loss of hair after delivery. Although hair loss is certainly a symptom of active SLE, this again is most likely a result of the changes that happen during a normal pregnancy.