Systemic Lupus Erythematosus and Pregnancy - Safety, and Precautions

Is Pregnancy Safe With Systemic Lupus Erythematosus?

• Systemic lupus erythematosus is an autoimmune disease that primarily affects women during their fertile years. Therefore, women who are suffering from systemic lupus erythematosus and want to get pregnant should take it seriously and plan for a safe pregnancy.

• According to rheumatologists (a doctor who specializes in the field of diagnosis and treatment of disorders related to the immune system), it can be safe to get pregnant along with the disease, but there is always a higher risk of complications associated with pregnancy for both the mother and the developing fetus.

• There is an increased risk of abortion, fetus death in the uterus, preterm birth, stillbirth, and fetal growth retardation in pregnant women suffering from systemic lupus erythematosus.

• The females should go ahead with their pregnancy when the disease state is quiescent for a minimum period of 6 months, and the kidneys are functioning normally in the mother.

Does Systemic Lupus Erythematosus Affect Fertility of a Woman?

• The systemic lupus erythematosus mainly affects women during their reproductive years. Therefore the disease diagnosis comes with many questions, including whether the fertility of a woman is affected by it or not.

• According to rheumatologists, systemic lupus erythematosus does not alter the fertility of a woman. A female suffering from lupus is just as likely to become pregnant as other females who are not having the disease.

• However, a reduction in the ova count was observed in females who were consuming Cyclophosphamide (an immunosuppressant drug).

• However, pregnancy in females with an active disease state is considered to be at high risk.

How the Pregnancy Should Be Planned in Systemic Lupus Erythematosus?

• Avoid Pregnancy During the Active Phase of the Disease- The pregnancy should not be planned during the active lupus phase since it poses a high risk of pregnancy complications both for the mother and the developing baby.

• Ideally, all women suffering from the disease should plan their pregnancy during the inactive or quiescent state of the disease.

• Contraceptive Counseling- To avoid unplanned pregnancies during the active phase of the disease, it is very important to educate the females affected by the disease about effective contraceptive counseling.

• Intrauterine Device Contraception- The barrier methods of contraception have a higher failure rate. Certain immunosuppressive drugs interfere with the efficacy of oral contraceptive drugs. Hence the intra-uterine contraceptive device is the most effective and safe method of contraception in the affected females.

• Preconception Evaluation- All lupus-positive females should undergo a preconception assessment as the active disease may pose a high maternal and fetal risk justifying the need to avoid pregnancy.

1. The patient should opt for preconception counseling, fetal risk assessment, and maternal risk factors before conception.

2. A unique set of specific autoantibodies (aPL and anti-Ro antibodies) produced in the mother poses a high risk to the developing fetus.

3. Efforts should be made to control the disease activity for a minimum period of six months before conceiving the child.

4. Hypothyroidism in systemic lupus erythematosus patients is associated with a poor prognosis. Therefore, thyroid activity should also be evaluated properly.

What Does Systemic Lupus Erythematosus Do to the Pregnancy?

Systemic Lupus Erythematosus is an autoimmune disorder where the immune cells of the body start attacking the healthy tissues of the body. Therefore lupus poses a high risk to pregnancy, including

• Preterm Birth- It is a common complication in lupus-positive females. The risk factors for the disease include the active disease phase, high corticosteroid usage, and thyroid disease.

• Preeclampsia- A dangerous complication characterized by increased blood pressure (hypertension) in pregnancy. Lupus females suffering from preeclampsia have an increased rate of poor pregnancy outcomes, including high blood pressure, abortion, and fetal growth retardation, as compared to other females who do not have this disease. Preeclampsia has a close resemblance to lupus nephritis (a condition where the autoantibodies in the lupus patient start attacking the structures in the kidneys). It is important to differentiate the condition from lupus nephritis. Serum uric acid is elevated in patients with preeclampsia.

• Pregnancy Loss and Antiphospholipid Antibodies- Antiphospholipid antibodies pose a high risk in pregnancy, leading to pregnancy loss. Sometimes it also leads to preterm births and intrauterine growth retardation.

What Does Pregnancy Do to the Systemic Lupus Erythematosus?

• Pregnancy is associated with a high risk of the flare of systemic lupus erythematosus.

• The flares of the lupus are mild.

• In rare cases, flares of lupus nephritis are experienced by the patient.

What Does Systemic Lupus Erythematosus Do to the Newborn?

• Neonatal Lupus- It is a temporary condition characterized by an erythematous rash and blood and liver abnormalities. It usually lasts for six to eight months after birth. It occurs due to the maternal autoantibodies that cross the placenta and are acquired by the newly born.

• Congenital Heart Block- It is a serious complication of neonatal lupus, which can be detected early in the sonography, usually in the second trimester.

What Are the Medications Safe During Pregnancy?

• Nonsteroidal Anti-inflammatory Drugs- Their first-trimester use may be associated with a risk of congenital malformations. They should be used cautiously during the first and second trimesters and discontinued during the third trimester.

• Corticosteroids- High doses can lead to maternal complications. Use the lowest dose possible.

• Antimalarials- The risk is reduced if the disease flares. It should be continued in all lupus pregnancies.

• Immunosuppressants- Late developmental delays are seen in newborns. The dosage should be limited to 2mg/kg/day.

• Antihypertensives- Growth retardation is seen in some cases. Safe and recommended drugs to use in pregnancy.

What Is the Ante-Natal Management in Systemic Lupus Erythematosus?

• Regular Monitoring by Doctors- There should be close and frequent monitoring of pregnant women for ante-natal management by rheumatologists and gynecologists.

• Thorough Medical Examination- An extensive medical examination and laboratory tests should be tailored according to the profile of the patient at risk.

• Lifestyle Modifications- The patient should focus on good sleep and healthy, nutritious food.

• Physical Exercise- Working out is essential to build good hormones, as recommended by the gynecologist.

Can Women Breastfeed With Systemic Lupus Erythematosus?

The answer is yes, but certain medicines need to be avoided while breastfeeding since they can pass into the breast milk and cause damage to the infant. If the medicines are necessary to control lupus, then one might need to stop breastfeeding and should consult the gynecologist for lactation counseling.

Conclusion

It is possible to have a healthy and safe pregnancy with systemic lupus erythematosus, but proper planning is required. Lupus should not be taken lightly. A multidisciplinary team is needed, including rheumatologists and gynecologists, for careful and safe planning of the pregnancy till the delivery of the fetus.