Pregnancy and lupus

Lupus (systemic lupus erythematosus, or SLE) doesn't generally affect a woman's ability to conceive. However, if you are having a lupus flare or are taking corticosteroid medications, you may have irregular menstrual cycles, making it difficult to plan a pregnancy.

If you plan to have a baby or are already pregnant, it is very important that you and your primary doctor discuss how lupus may affect your pregnancy.

• Most women with lupus have successful pregnancies. Women who become pregnant during lupus remission are more likely to have a successful pregnancy.
• Lupus increases the risk of fetal and pregnancy complications, including premature birth and stillbirth. This risk is greatest among women who have kidney problems or antiphospholipid, anti-Ro, or anti-La antibodies.¹
• Some women with lupus need to take medications or have regular fetal monitoring or ultrasound while they are pregnant to reduce the risk of complications.
• Women with mild or well-controlled lupus at conception are less likely to have disease flares during pregnancy. Flares during pregnancy are usually mild.² Some women do have serious flares during pregnancy.³

If you have miscarried before, expect that your pregnancy will be closely monitored. Talk to your doctor about whether you have tested positive for antiphospholipid antibodies. If so, anticoagulant treatment may improve your chances of having a healthy pregnancy.

Can I still take my lupus medications?

You may not be able to stop taking lupus medications after becoming pregnant, or you may need to start taking medication for a symptom flare. Some lupus medications, like acetaminophen and prednisone, are considered safe during pregnancy. Others may not be.

• Immunosuppressant medications, which may be prescribed for severe lupus, can cause birth defects. Do not take immunosuppressants if you are pregnant or wish to become pregnant.
• Some corticosteroids (such as prednisone) are generally considered safe for use during pregnancy because they do not reach the fetus in an active form.³
• Cytotoxic medications such as methotrexate are stopped during pregnancy. They should be discontinued several months before conception.
• One study suggests that hydroxychloroquine (such as Plaquenil) is safe for use during pregnancy.⁴
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin should be avoided during pregnancy unless prescribed by a doctor.

Citations

1. Lockshin MD (2005). Systemic lupus erythematosus. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 4. New York: WebMD.

2. Ruiz-Irastorza G, et al. (2001). Systemic lupus erythematosus. Lancet, 357(9261): 1027-1032.

3. Hahn BH (2005). Management of systemic lupus erythematosus. In ED Harris et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1225-1247. Philadelphia: Elsevier Saunders.

4. Costedoat-Chalumeau N, et al. (2003). Safety of hydroxychloroquine in pregnant patients with connective tissue diseases. Arthritis and Rheumatism, 48(11): 3207-3211.