Will the pregnancy affect my lupus?
It's difficult to give advice for everyone as lupus can vary from mild to severe. Although all lupus pregnancies are still considered 'high risk', improvements in healthcare have meant that many patients with lupus have had no complications, particularly if their pregnancy has coincided with a quiet phase of their disease (remission). If, however, you have severe lupus you may be advised against having a baby as pregnancy can put an enormous strain on your heart, lungs and kidneys.
For most women, however, it's safe to proceed under careful supervision. It's always best to discuss this with your doctor or rheumatology nurse specialist before conception.
Women with lupus who want to become pregnant should do so during one of these quiet phases of their disease, and after talking to their doctor or rheumatology nurse specialist. You may stay in remission or have flare-ups while you're pregnant, although flare-ups involving the skin and joints are less likely towards the end of pregnancy.
You should take care about the drugs you take during pregnancy; however, the risk of a problem to the baby may be greater if you don't take the drugs necessary to keep your lupus under control or if you stop them suddenly, so it's vital to discuss and plan pregnancy in advance with your doctor.
While your doctor will try to avoid using drugs if possible, it's fine to use steroids, hydroxychloroquine and azathioprine throughout pregnancy.
Will my lupus affect the pregnancy?
Some women with lupus do have a higher risk of complications during pregnancy, though most will have a successful pregnancy. Your pregnancy will be closely monitored, and your obstetric consultant will need to see you frequently in the antenatal clinic. There’s a higher risk of miscarriage if you have lupus, and the miscarriage may be later than usual in the pregnancy – up to 24 weeks if you also have antiphospholipid syndrome (APS).
Planning your pregnancy will mean that your lupus specialists and the obstetric team can work closely together. Because babies born to women with lupus can be smaller than average, you may be advised not to have your baby at your local hospital but at a more specialist site where they can work better as a team and which has the best facilities to look after very small babies.
You and your baby may be checked more often than most women during pregnancy. If your lupus is mild you probably won't need any extra scans, but you may need additional scans if your disease is more severe, especially if your kidneys are affected, or if you test positive for certain antibodies in your blood.
These antibodies are called lupus anticoagulant, anticardiolipin and anti-Ro, and these tests will usually be done either before you become pregnant or early in the pregnancy. Read more about how blood tests are used to help doctors manage pregnancies.
The medical team will also use other ways of monitoring your baby, which may include regularly monitoring its heartbeat and checks on the blood flow to the womb and the umbilical cord (using ultrasound scans). Your blood pressure and urine will also be checked regularly.
What types of problem can happen with lupus later in pregnancy?
If you have kidney disease from your lupus or your blood pressure is high before you become pregnant your blood pressure may increase during pregnancy. If that happens after 20 weeks of pregnancy with protein in your urine it’s called pre-eclampsia, so you'll need regular checks for blood pressure and for protein in your urine.
High blood pressure can cause severe headaches and vision problems, so you should talk to your doctor if you develop these symptoms during pregnancy.
Your baby may not grow as fast as normal (growth restriction), and your waters may break much earlier than usual or you may go into labour early (pre-term delivery).
There's some evidence that a low-dose aspirin tablet taken every day can lower the risk of some of these problems. Your doctor will discuss this with you when you first go to the antenatal clinic.
Will my lupus affect the labour?
You should have a normal labour. But if you go into labour too early, the doctors may try to stop you giving birth, with drugs, to allow more time for the baby's lungs to mature. Doctors may sometimes feel that it’s safer (for you or for the baby) if your baby is delivered by caesarean section. This option would be discussed with you during the pregnancy, well before the time of labour.
Will my lupus affect the baby?
There's a risk of babies born to mothers with lupus being smaller than usual. If that happens, your baby may need to spend a few days in the newborn (neonatal) nursery. If your baby is born very early, they'll spend longer in the nursery and may need help with breathing initially.