Lupus and Pregnancy
A healthy pregnancy with lupus is possible — but lupus raises your risk for certain complications during pregnancy. If you have lupus and you’re planning to get pregnant, work with your doctors to plan a healthy pregnancy.
Before you get pregnant
Talk with your doctor about your plans in advance — at least 3 to 6 months before you want to start trying to get pregnant. Early talks with your doctor will allow you to have a plan for a safe pregnancy. You may need to change your lupus medicines 3 to 6 months before you start trying, so planning ahead is important. Together, you can make a plan to lower your risk of problems during pregnancy.
It is best to wait until your lupus is minimally active and your symptoms are under good control on medications that are safe to take during pregnancy.
If you’re not ready to get pregnant right now, it’s important to use birth control to prevent an unplanned pregnancy.
Am I at higher risk for pregnancy complications?
Everyone with lupus has a higher risk of pregnancy complications. But some things may raise your risk even more, like:
- High blood pressure
- Kidney problems
- Problems with your blood, like blood clots or not having enough platelets
- Having a certain type of proteins (called antiphospholipid antibodies) in your blood that may increase your risk for blood clots and pregnancy loss.
Your risk is still higher if you had these problems in the past, even if you don’t have them now. Your risk is also higher if you had complications during a past pregnancy.
Talk with your doctor about your risk for pregnancy complications and make a plan to help prevent them.
If you work closely with your doctors and wait to get pregnant until your symptoms are under control, you have an excellent chance of having a healthy pregnancy.
Can I keep taking my lupus medicines?
That depends on which medicines you’re taking. Some lupus medicines, like hydroxychloroquine (Plaquenil®), are safe to take during pregnancy. But some other lupus medicines, like methotrexate (Rheumatrex®), can cause serious birth defects.
It’s also important to know that some lupus medicines can stay in your body for several months after you stop taking them. You may need to stop or switch treatments up to 3 months before you start trying to get pregnant.
If you’re planning to get pregnant, ask your doctor which lupus treatments are safe for you.
Don’t panic — just tell your doctor right away. Your doctor can help you stop or switch treatments and talk with you about the risk of birth defects. Remember, your doctors are here to support you and help you find the right treatment plan.
A special doctor called a maternal-fetal medicine specialist can work with your rheumatologist and your other doctors to help you stay healthy during pregnancy.
Make sure you understand how often you need to see the doctor during your pregnancy — and never skip a visit. These appointments are very important because the doctor can test your blood and urine (pee) to check for signs of problems with your pregnancy. These tests help find problems early, when they may be easier to treat.
Plan to give birth in a hospital that has a neonatal intensive care unit (NICU). A NICU can take better care of your baby if there are any complications.
What pregnancy complications am I at risk for?
Many people with lupus have healthy pregnancies. But lupus does raise your risk for several serious complications, including:
- Blood clots
- Kidney problems
- High blood pressure, which can lead to a serious condition called preeclampsia
- Growth problems (when the baby grows too slowly in the womb)
- Premature birth (when the baby is born too early)
- Miscarriage (loss of a pregnancy before 20 weeks of pregnancy)
- Stillbirth (loss of a pregnancy after 20 weeks of pregnancy)
- Having a baby with neonatal lupus or heart block (rare condition that can affect the baby)
Some people with lupus have antiphospholipid antibodies — certain proteins in blood that can increase the risk of blood clots and miscarriage. If your blood tests show that you have these antibodies, your doctor may give you medicine to help prevent blood clots during pregnancy.
What is preeclampsia?
Preeclampsia is a serious blood pressure problem that happens during pregnancy. If it’s not treated early, it can cause other health problems including kidney damage, problems with blood clotting, and seizures.
People with lupus are at higher risk for preeclampsia and a related condition called HELLP syndrome. HELLP syndrome causes serious problems with the liver and blood.
Preeclampsia can be very dangerous — but early treatment makes a big difference. Get help right away if you have any of these symptoms while you’re pregnant:
- Blurry vision or sudden changes in your vision
- Severe headaches
- Severe pain in your upper abdomen (usually under your ribs on the right side)
- Trouble breathing or severe shortness of breath
How can I prevent preeclampsia?
Taking low-dose aspirin (also called baby aspirin) every day may help lower your risk for preeclampsia. Talk with your doctor about taking low-dose aspirin during pregnancy.
Tell your doctors right away if your lupus symptoms come back or get worse while you’re pregnant. Your doctors can treat your symptoms with medicines that won’t harm your baby.
Some people develop preeclampsia or HELLP syndrome just after they give birth. It’s rare to develop these problems after leaving the hospital — but if you have symptoms of these conditions after you give birth, get help right away. Schedule a follow-up visit with your rheumatologist 2 to 3 months after your baby is born. Your doctor will check on your lupus symptoms and talk to you about starting to take medicines again that you had to stop during pregnancy.
Can I breastfeed my baby?
Breastfeeding (also called nursing or chestfeeding) is healthy for you and your baby. Some lupus medicines can pass into breastmilk, so it’s important to ask your doctor which medicines are safe to take while breastfeeding.
Will my baby be born with lupus?
No — but some babies born to mothers with lupus get a condition called neonatal lupus. Neonatal lupus is not the same type of lupus adults get, and it doesn’t mean that these babies will have lupus when they grow up.
The most common symptom of neonatal lupus is a rash on the baby’s face. The rash usually goes away within 6 months after birth. Rarely, babies with neonatal lupus get a condition called congenital heart block that can be identified during pregnancy. Babies with congenital heart block require immediate care after birth and may need a pacemaker to help control their heartbeat. Seeing a perinatologist (maternal fetal medicine doctor) during pregnancy is an important part of a safe and healthy pregnancy and baby.
During pregnancy, your doctor will test your blood for anti-SSA/Ro and anti-SSB/La antibodies — certain proteins that increase your baby’s risk for a heart block. You may also need a test called an ultrasound to check for problems with the baby’s heart.
Remember, most babies of mothers with lupus are born healthy. You can work together with your doctors to have a healthy pregnancy.