Most women with lupus should be able to have a baby if they wish to, but it's best to discuss your plans with your doctor before trying to get pregnant so that your treatments can be altered if need be. Try to plan your pregnancy when your lupus is inactive and you're taking as little medication as possible.
A small number of women with very severe lupus may be advised against having a baby as pregnancy can put a great strain on the heart, lungs and kidneys. There's an increased risk of pregnancy complications in women whose lupus affects a number of different organs and who find it difficult to control their symptoms without certain medications.
If you're thinking of having a baby, always discuss your plans with your doctor or specialist nurse before you start trying. You may need to see an obstetrician with a special interest in lupus for further advice.
Doctors are naturally cautious about which drugs are used during pregnancy. Steroids are usually well tolerated and many people have used prednisolone, hydroxychloroquine and azathioprine throughout pregnancy without ill effects.
If you have high levels of antiphospholipid antibodies, there's an increased risk of miscarriage. However, treatment with aspirin and/or heparin reduces this risk, and there are now many more successful pregnancies in women who have these antibodies.
There's conflicting evidence about whether pregnancy is likely to cause a flare-up of lupus. If your condition is well controlled at the time the baby is conceived, and you don't have kidney disease, then you're unlikely to have any problems.
If you do have kidney disease, then you may well have increased protein in your urine during the later stages of pregnancy. It is important, but sometimes difficult, to distinguish between protein in the urine due to kidney disease which is associated with lupus, or to a more common complication of pregnancy, known as pre-eclampsia. The doctors looking after your pregnancy will check for this and consult your rheumatologist if they need to.
In pregnant women who have anti-Ro antibodies there's a small risk (about 1 in 50) that their babies will have neonatal (newborn) lupus syndrome. This means the baby may have a rash and/or a slow heartbeat. There's a slightly greater risk in following pregnancies, so make sure you discuss this in detail with your rheumatology and obstetric team before considering another pregnancy. Most babies born to mothers with anti-Ro antibodies will be fine, but it's important to have regular scans of the baby's heart during the pregnancy.