Lupus Pregnancy

Lupus is an autoimmune disease that affects women 10 to 15 times more than men. Women are most likely to develop lupus between the ages of 15 and 40, so researchers suspect a connection between hormones and lupus. For many years women were discouraged from becoming pregnant if they had lupus because of risks associated with the health of the mother and child.

Risks of Lupus and Pregnancy

Lupus does carry real risks for a mother and her fetus. Up to 10 percent of pregnancies in women who have lupus end in miscarriage. Some of the underlying maternal conditions that can lead to miscarriage are diabetes mellitus, hypothyroidism and systemic lupus erythematosus. First trimester miscarriages may have some connection with active lupus during pregnancy. Later miscarriages are connected to a condition known as antiphospholipid antibody syndrome or APS. Women with lupus who wish to become pregnant should be screened for APS.

Anticoagulants and APS

APS may cause blood clots, strokes, heart disorders and frequent miscarriages. Women who have a history of blood clots or thrombosis and one or more miscarriages should be screened for APS, genetic or chromosomal abnormalities and maternal anatomical problems.

To diagnose APS, a blood test is performed to determine the presence of lupus anticoagulant or anticardiolipin antibodies in the blood. Treatment with anticoagulants such as aspirin, or a combination of aspirin and heparin has shown some promise in thinning the blood and preventing thrombosis and miscarriage. Still, these pregnancies are considered high-risk and should be monitored and evaluated closely.

Preeclampsia and Pre-Term Birth

Another risk associated with systemic lupus erythematosus and pregnancy is pre-term birth. Pre-term birth in lupus is usually not associated with APS but, rather, with preeclampsia. Preeclampsia is a condition caused by damage to the placenta that occurs in the second term of pregnancy.

Women suffering from preeclampsia may have symptoms of high blood pressure, headache and swelling. Preeclampsia can lead to early rupture of the membranes and early birth, which can contribute to the delayed growth of the fetus. The mother’s blood pressure should be monitored carefully and treated conservatively. Over-treatment can lead to the reduction of blood flow to the placenta.

Lupus Flare-Ups in the Mother

Women may experience flare-ups of lupus during pregnancy because of the increased presence of the pregnancy hormone prolactin. Prolactin is the hormone associated with the production of breast milk. The lupus flare-ups during pregnancy can be more severe because they are more likely to affect the kidneys and circulatory system rather than the skin and joints.

Reducing Risks for Pregnant Women

Treating or controlling underlying diseases like diabetes, hyperthyroidism and high blood pressure prior to pregnancy may reduce risks during the pregnancy. Routine screening for antiphospholipid antibody syndrome and lupus anticoagulant should be included in prenatal care. Other tests such as monthly complete blood counts, liver function tests, urinalysis and creatinine tests should also be included.

Resources

Beers, M.H.