Chat Transcript for Dr. Rosalind Ramsey-Goldman
August 8, 2007
Moderator
Good afternoon. The Lupus Foundation of America is pleased to welcome Dr. Rosalind Ramsey-Goldman.
Dr. Rosalind Ramsey-Goldman's interests lie primarily in the clinical treatment of and research in understanding the natural history of systemic lupus erythematosus (SLE). Lupus is an autoimmune disease that can attack any system of the body, from the skin, joints, and kidneys, to the brain, heart, and lungs. The disease affects women nine times more often than men, and most commonly manifests itself during the childbearing years. SLE also is more common in African Americans. Preliminary evidence suspects that there may be a higher prevalence in other minorities, too.
Specific interests of Dr. Ramsey-Goldman include the effects of lupus on pregnancy, the correlation between bone disease and immunosuppression, the epidemiology of SLE, genetics and SLE vascular disease and SLE, and a range of clinical trials related to the treatment of lupus and its debilitating symptoms.
Dr. Ramsey-Goldman’s goal is to improve the quality of life for lupus patients through her epidemiological, pregnancy, and drug studies.
We welcome Dr. Ramsey-Goldman, and thank her for joining us this afternoon.
Moderator
Without further delay, let's begin. Here's the first question. Can I get pregnant if I have lupus?
Dr. Ramsey-Goldman
Yes, a woman with lupus can get pregnant. In general she has the same chance of getting pregnant as a woman without lupus.
Moderator
For 8 months I had active lupus, since then I’ve been fine with prednisone 5mg/d, plaquenil and syndrome. Should I get pregnant now; I mean, will that be so harmful? -- Michoacán, México
Dr. Ramsey-Goldman
You should plan your pregnancy after consulting with your rheumatologist. You want to plan the pregnancy during a time when the disease is controlled and has been inactive for at least 6 months.
Moderator
I am 36 years old and I am in complete remission of symptoms. My life is very good I have a wonderful job, and I do everything. I would like to have a child next year. I don't have children. My diagnosis is SLE. I have had SLE since 1985. All my analysis are good. But I’m very scared that my baby may die or I may die. -- San Juan, Puerto Rico
Dr. Ramsey-Goldman
Your doctor will review your experience with lupus and the medications needed to control your disease. The doctor will also assess if any organ damage has occurred and if that damage might interfere with pregnancy. If planned properly, you could have a good chance of a successful pregnancy.
Moderator
My best friend is 28 and has lupus. She wants to have a baby and I am concerned what the risks may be for her and the baby if she were to get pregnant. She is currently taking a lot of prescription meds and that is another thing I am concerned about. Thank you. -- Lancaster, PA
Dr. Ramsey-Goldman
The most important goal is to have the mother’s disease well controlled even if that requires medication. A healthy mother is the best chance for a baby to be well. Medications may need to be used during pregnancy and a specialist who has experience using medication will advise as to the safest medication that can be used to control the mother’s symptoms and not likely to harm the baby.
Moderator
I have read that women with lupus may experience menopause early. Should there be any caution with waiting "too long" to have children because of this risk factor? If so, are there any tests that can be taken in order to find out if the woman biologically still has time to plan children? -- Houston, TX
Dr. Ramsey-Goldman
Some women with lupus go through the menopause early especially if they have received a medication like cyclophosphamide. If there is a question about fertility, the woman should see a specialist in this area to best assess future pregnancy potential.
stracsl
Are there greater risks for women with lupus wanting to become pregnant (for the first time) after the age of 30?
Dr. Ramsey-Goldman
There is usually no greater risk to your lupus or pregnancy than those normally associated with aging if you have lupus and you are over the age of 30. What is most important is that your lupus is controlled and inactive for at least 6 months prior to and stays that way while you are pregnant.
Amy
What exactly is it about a mother's lupus that can create fetal heart block in her baby, while in utero?
Dr. Ramsey-Goldman
If the mother has certain antibodies, SSA and/or SSB, these can pass from the mother's blood through the placenta and into the baby. In rare circumstances these antibodies cause damage to the baby's heartbeat causing heart block.
Moderator
What types of medication can pregnant lupus patients take?
Dr. Ramsey-Goldman
Low dose aspirin, heparin shots, prednisone, plaquenil (hydroxychloroquine), and imuran (azathioprine) have been used during pregnancy in women with lupus. It is a mistake not to treat the disease if active or to prevent activity when one is considering pregnancy. Getting sick with lupus and trying to avoid treatment prior to getting pregnancy or when pregnant could have bad results the mother and baby.
Moderator
Is it safe to get pregnant while on Plaquenil? What are the risks for the baby if on Plaquenil? -- Hawthorne, CA
Dr. Ramsey-Goldman
Most rheumatologists who treat lupus patients use plaquenil during pregnancy if that is the best drug for that patient. Studies do not show an increased risk of baby problems. In a study in pregnant women, if the drug was stopped they may be more likely to flare than those who took the medication. The pregnancy outcome is better if no flare occurs.
MAITAI
Hello Dr Goldman, my name is Renika and I have been diagnosed with both systemic and discoid lupus. I plan on having another baby sometime this year. Is it okay to continue with the Cellcept medication and the prednisone?
Dr. Ramsey-Goldman
You can continue taking prednisone during pregnancy, however, there have been recent reports of problems in baby's exposed to Cellcept in utero. Therefore, we recommend that Cellcept be discontinued. If more treatment is needed then another medication that is safer to use during pregnancy should be substituted for Cellcept.
Moderator
My sister-in-law is willing to carry a baby for my husband and me. If I have to take methotrexate, will my eggs be good? Is the procedure even possible? -- Scottsdale AZ
Dr. Ramsey-Goldman
If someone is on methotrexate, we advise the woman or man to be off the methotrexate for 3-6 months before attempting pregnancy, or donating eggs or sperm.
maria
When you say "inactive for 6 months" does that include quiet disease that is controlled by constant medication usage?
Dr. Ramsey-Goldman
Yes. It would be desirable to have that quiet time on medications that could be used during pregnancy as well.
Moderator
I have an aggressive form of lupus. I am currently in remission, but do get the occasional UTI, pyelonephritis. I am currently on 1/2 cortisone, 5mg pharmapress and 10mg trepiline and I will be getting married next year. Should I go on birth control or could I have a child? I had initially cresentic nephritis; now I have chronic renal failure. My creatinine is 320. What do you think I should do? My kidneys are damaged by 70%. I can’t go onto immunosuppressants; they almost killed me and I'm not on dialysis. I have had SLE from the age of 13. -- Cape Town, South Africa
Dr. Ramsey-Goldman
Even if the lupus kidney disease is no longer active, if there has been damage to the kidneys, pregnancy may not be possible. The kidney needs to work well enough to support the extra demands of blood flow during pregnancy. The kidneys must work better than 50% of normal, the protein leak must be minimal, and the blood pressure must be controlled.
Moderator
I know there are some increased risks during pregnancy for those who have lupus nephritis. How can someone with lupus nephritis attempt to make the best decision for their body, in terms of whether or not to pursue pregnancy as a way to grow their family? What should they consider? -- Bellingham, WA
Dr. Ramsey-Goldman
The kidney disease must be controlled quickly in order to minimize damage to the kidneys. Both lupus medications as well as blood pressure medications may need to be used. If the kidney disease can quiet down and remain stable for 6-12 months, the kidney function is normal or close to normal, then a pregnancy can be considered.
Shawn
Will a pregnancy increase your chances of having a lupus flare-up?
Dr. Ramsey-Goldman
If disease is controlled or inactive when you become pregnant, the chances of flare are low and if a flare would occur it is likely to be mild. If a woman becomes pregnant when the disease is active, then the chance of a flare is higher and the flare itself could be severe.
cbone
Can a person with very early stages of lupus go untreated until after giving birth? What kind of flare-up could they expect?
Dr. Ramsey-Goldman
We generally recommend that pregnancy be deferred early in the disease course in a woman with lupus. We do not know how the disease will affect the woman or if medications will be needed. Again, careful planning ahead of time gives the best chance of a good outcome for both mother and baby.
Debbie
If I currently have no kidney involvement, will a pregnancy increase chances of kidney problems in the future?
Dr. Ramsey-Goldman
If the woman has had disease for several years, it has been and is currently inactive/controlled and has not previously included kidney problems, there is only a very small chance that a new kidney problem will surface as a result of a pregnancy.
Moderator
Which lupus patients are not good candidates for pregnancy? What are the risks for the mom passing lupus to her unborn child? -- Fort Worth, TX
Dr. Ramsey-Goldman
Although there is a genetic predisposition to get lupus, there is no one bad gene that makes you have lupus. In fact, there may be over 100 genes that would contribute to someone’s risk to developing lupus. Therefore, the chances of passing lupus on to your child is small, probably less than 5%.
Moderator
What are the chances that my children may get lupus? Is there a way to prevent this from happening with my children since we know that I have it, for example, by avoiding certain antibiotics, certain foods, sun exposure, etc.? -- Hartford, CT
Dr. Ramsey-Goldman
We do not have any prevention strategies that are known to work with reducing the risk that a family member will get lupus. However, it is always a good idea to limit sun exposure since this is important for skin cancer prevention and to minimize aging effects from the sun. Lastly, it is important to make sure you do not smoke nor your children, because cigarette smoking has been associated with an increased risk of developing an autoimmune disease especially when there is a genetic predisposition or susceptibility in the family.
jenn
What other things, besides have inactive lupus for 6 mos and get the ok from her docotor, can a woman do to prepare for a healthy pregnancy? For example, what types of foods are best and are there appropriate nutritional supplements needed?
Dr. Ramsey-Goldman
Other lifestyle measures one can take are to maintain a healthy diet and not be overweight, exercise regularly, treat other conditions like high blood pressure or high cholesterol, and stop smoking. If one is anemic or has "low blood" ask the doctor if iron supplements are needed. Make sure your calcium intake includes at least 1000mg per day and also take vitamin D along with you calcium. Lastly some obstetricians recommend taking a folic acid supplement.
Moderator
Is it possible for the effects of lupus to subside during pregnancy? -- Cincinnati, OH
Dr. Ramsey-Goldman
Yes SLE symptoms can subside in some patients with SLE when they are pregnant. We don’t know why this happens, but it is really great when it does.
Jamie
How can I find an obstetrician who is familiar with patients who have lupus?
Dr. Ramsey-Goldman
Ask your rheumatologist to recommend an obstetrician who treats high risk patients.
Moderator
That is all the time we have for today’s chat. Thank you to Dr. Rosalind Ramsey-Goldman for joining us.
Please join us Wednesday, September 12 at 3 p.m. EDT for our guest Mr. Ken Getz from the Center for Information and Study on Clinical Research Participation. Mr. Getz will discuss clinical trials and lupus.
Check out the Summer 2007 issue of Lupus Now magazine. http://www.lupusnow.org. Check out the LFA’s new blog, On the Road to a Cure, located here http://lfa-inc.blogspot.com/.
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