Most people with Lupus can safely get pregnant and with appropriate support and care can have normal pregnancies and healthy babies. However, pregnancy with SLE carries a higher risk to mother and baby compared with pregnancy in women with no medical concerns. For this reason, your maternity team will consider such pregnancy as ‘high risk” to ensure that care is appropriate for your clinical condition and involves several healthcare professionals.We recommend that you access the BUMPS website (Best Use of Medicines in Pregnancy), for information and advice relating to medications taken prior to and during pregnancy. It is important not to stop any medication before checking with your doctor as this may be harmful to you or your baby.
What does this mean for my pregnancy?
For me:
In general, pregnancy does not cause flares (worsening) of SLE, but higher risk of flares is noted in women who have had flares within the six months prior to pregnancy, have had very active disease, or if SLE treatment has been stopped. If flares happen, they often occur during first or second trimester of pregnancy or in the first few months after the birth.It is vital to report flares promptly as they increase the risk of complications. Complications can include pre-eclampsia, blood clot in deep veins or lung, severe infection, and stroke.
For my baby
SLE in pregnancy increases the risk of miscarriage, preterm birth, slower growth in the womb (intrauterine growth restriction) and stillbirth, compared to a woman with no medical concerns. Factors such as previous miscarriage, antiphospholipid syndrome, active Lupus before or during pregnancy, kidney disease and pre-eclampsia increase this risk.Your blood tests will include checking your antibodies status for anti-Ro and anti-La antibodies. If these are present, there is a small chance these antibodies may cross the placenta and therefore could affect the baby causing a 2% risk of congenital heart block and 5% risk of cutaneous neonatal lupus (where certain antibodies cross from mother to baby). However, having neonatal Lupus does not appear to increase the chance of your baby developing SLE in adult life.
What will the medical team recommend?
The aim will be to personalise the care to you and your clinical condition. You will be seen more frequently in a specialist consultant-led maternal medicine antenatal clinic and offered regular scans to monitor baby’s growth, alongside the care provided by your midwifery team.If you have Ro and La antibodies, the team will organise a specialist heart scan for your baby (echocardiogram).You will be advised to take 75mg of aspirin each night from 12 weeks until 36 weeks to reduce your risk of pre-eclampsia. You may require calcium supplementation. Since there is an increased risk of developing a blood clot (thrombosis) you may be advised to take additional medication such as blood-thinning injections.Other medical treatment will be tailored according to your disease severity and will be discussed in detail by your clinical team.
What tests will/may be considered? How often may they be needed?
At the start of pregnancy, baseline blood tests will also include kidney and liver function tests, antibody tests like anti-Ro and La antibodies, if these haven’t been done previously, and other disease relevant tests. Urine will be tested for protein. Based on your past medical history, other tests like echocardiogram, lung function test may be considered. If you are at risk of Vitamin D deficiency, these levels will be also be checked.Throughout the pregnancy, your blood pressure, urine protein levels and blood results will be closely monitored. More frequent blood pressure and urine checks will happen if you have hypertension, pre-eclampsia and/ or renal disease.
What symptoms and signs should I be looking out for?
Differentiating between pregnancy-related symptoms and those of SLE can be difficult. You may notice a range of changes throughout pregnancy that may be unrelated to your SLE, but it is important to mention any symptoms that are worrying you.You must try and avoid triggers that you may know can set off your flare ups.
What are the symptoms/concerns, which mean that they should be reported immediately?
Flares of SLE is when your symptoms worsen and make you feel unwell. Often, this involves symptoms you have noticed previously, and some people may also develop new symptoms. Common symptoms that indicate a flare include raised body temperature not due to an infection, painful and swollen joints, increase in tiredness, rashes, ulcers in your mouth or nose and increased swelling of your legs.You should also immediately report symptoms like shortness of breath, chest pain, heart palpitations, painful swollen calf, feeling unwell; severe headache, seeing flashing lights or experiencing pain in upper tummy, contractions, vaginal bleeding, rupture of membranes or reduced baby movements.
How are recommendations made regarding my care?
Treatment options
There are overarching guiding principles on the use of medications during pregnancy and breast feeding. Based on the individual clinical condition medications will vary. In general, SLE medications that are safe in pregnancy, during breast feeding and required to maintain remission and/or treat flares include hydrochloroquine, azathioprine, cyclosporine and tacrolimus. Aspirin and paracetamol are safe in pregnancy. Corticosteroids are safe to control active disease.Medications to control high blood pressure may become necessary.
Timing of birth
People with SLE are more likely to have a preterm birth, that is birth before 37 weeks. The risk is particularly increased in the presence of active Lupus, kidney disease, hypertension and pre-eclampsia. Birth may start spontaneously or may be induced due to concerns relating to your or your baby’s health.Your team will discuss the timing of birth with you, considering your and your baby’s health.
How may this impact my birth choices?
For most people with SLE vaginal birth should be possible, but choices will be influenced by how this pregnancy progresses, your previous births and other possible concerns.Discuss your personal birth preferences with the team.
How may this affect care after the birth?
Your team should make a care plan with you relating to your and your baby’s care after the birth.You will be given guidance on medications that need to continue and will be safe to take whilst breastfeeding. There is an increased risk of SLE flare after the birth and you must report these immediately so that the medications can be adjusted.You will require blood thinning medications as the risk of blood clots increases significantly after the birth. These may need to continue for up to six weeks after the birth.
What will this mean for future pregnancies?
It is important to plan all future pregnancies to improve your chances of a successful pregnancy. It is advisable to wait a year before trying for another baby and to conceive when your SLE has been inactive for at least six months on treatment. You must see your doctor, three to six months before you plan to start trying for a pregnancy to enable a full health assessment and medication plan. Use contraceptives till you are ready to try for another pregnancy.
