What are the risks with pregnancy when you have lupus?

Question

I have lupus and I would really like to have children. My doctor told me that I would be considered a high risk prenancy if I could even concieve at all. What are some of the risks and why?

Answer 1

Ok, I have Lupus and APS. For me I have to take Lovenox and aspirin through out my pregnancy to keep from clotting.

Yes, it is concidered a high risk pregnancy but, if following by a rheumatologist and perinatologist many women go on to have sucessful pregnancies. Conception issues tend to run with APS but not with Lupus.

Although a lupus pregnancy is considered high risk, most women with lupus carry their babies safely to the end of their pregnancy. Women with lupus have a higher rate of miscarriage and premature births compared with the general population. In addition, women who have antiphospholipid antibodies are at a greater risk of miscarriage in the second trimester because of their increased risk of blood clotting in the placenta. Lupus patients with a history of kidney disease have a higher risk of preeclampsia (hypertension with a buildup of excess watery fluid in cells or tissues of the body). Pregnancy counseling and planning before pregnancy are important. Ideally, you should have no signs or symptoms of lupus and be taking no medications for at least 6 months before you become pregnant.

Pregnancy counseling and planning before pregnancy are important.

You may experience a mild to moderate flare during or after their pregnancy; others do not. Pregnant women with lupus, especially those taking corticosteroids, also are more likely to develop high blood pressure, diabetes, hyperglycemia (high blood sugar), and kidney complications, so regular care and good nutrition during pregnancy are essential. It is also advisable to have access to a neonatal (newborn) intensive care unit at the time of delivery in case the baby requires special medical attention.

Answer 2

When my best friend was diagnosed with lupus, they told her that she shouldn't get pregnant because the disease in combination with the strain of pregnancy would be too much for her body to take.

Nevertheless, she did get pregnant and was considered high risk, but she delivered a healthy baby boy in March 2004. In September of that year, she started feeling very tired and unwell, and the doctors told her that the lupus was becoming quite aggressive. She ended up having a heart attack(the lupus attacked the tissues around her heart) and she died on October 17th, 2004. She was 25.

I don't mean to scare you, I am really not, I'm just telling you what happened to her so that you are aware that this is a possibility when you have lupus. If you want to have children, the options are open to you. You can adopt, have a surrogate, etc. Just be careful.

I hope this helps, and Good Luck in whatever decision you make.

Answer 3

I was just diagnosed with Lupus a week ago, thus I have been doing a ton of research. I have found many stories of woman having successful pregnancies with Lupus. You will just need to be seen by a Dr. on a more regular basis, and make sure you are ready for the chance (God forbid) of loosing a baby, as the information I have read stated it's actually around 4 mos of pregnancy that complications may occur. Just have faith, and be completely sure you are emotionally and physically ready. God bless!

Answer 4

First learn to control your lupus, then your concern for the pregnancy may not be such a worry. For many people, Lupus will respond well to very high nutrition levels. Explore the websites below. You will be amazed how this will change your life. Got more questions? Write to me at [e-mail] . I am glad to help.

Answer 5

It depends on if you have discoid or systemic. If you only have discoid it could progress into systemic. If you already have systemic a number of things can happen. Flare-ups can be worse when pregnant, because your immune system is already lower. The damage to your organs will likely progress faster, especially to your kidneys. All this is courtesy of your body not behaving how it should. My cousin just had her 2nd kid and is paying severely for it. She went into labor with her 1st kid at 6 months and was put on bed rest, almost the same thing happened with her 2nd kid. She will most likely need a kidney transplant, if even possible. If she would get pregnant again she has a 99 % chance of not making it. Sorry for the bad news but it is something that you need to talk extensively with your doctor and your family about. You also need to trust your doctors opinion.

Answer 6

why don't you ask your doc? he's going to be able to answer this better than anyone on here. you can also find info at www.lupus.org and type pregnancy in the search box. by the way, i've had 3 high risk pregnancies (for other reasons) and they've all come out fine.

Answer 7

death is possible. Also pregnancy could put unwanted stress on your body that u don't really need. One option is having a surrigate. Get as much information as u can about how your body is doing. U really have to weigh the options.

Answer 8

my neice has lupus and she has been pregnant five times. the first two died.she went to missouri and they helped her and she gave birth to her other two kids which were healthy and now she has one on the way!

Answer 9

Because lupus is a disease that strikes predominantly young women in the reproductive years, pregnancy is both a practical and a research issue. For most women with lupus, a successful pregnancy is possible. This is an immense change from the 1970's, when most women with lupus were counseled not to become pregnant. Studies of the immune system in pregnancy are of interest for what they have taught us about the effect of hormones on lupus flares.First, the risks of pregnancy in lupus patients are real and involve both the mother and the fetus. About ten percent of pregnancies currently end in miscarriage. The first trimester losses appear either to have no known cause or to associate with signs of active lupus. Later losses occur primarily due to the antiphospholipid antibody syndrome, inspite of treatment with heparin and aspirin. All women with lupus, even if they do not have a previous history of miscarriage, should be screened for antiphospholipid antibodies, both the lupus anticoagulant (the RVVT and sensitive PTT are the best screening battery) and anticardiolipin antibody.
The classification criteria for the antiphospholipid antibody syndrome were revised last year. There are now two major criteria--vascular thrombosis and pregnancy morbidity. A woman who has had a past venous or arterial thrombosis should be therapeutically anticoagulated during the next pregnancy. A woman who has pregnancy morbidity--one or more late losses, three or more first trimester losses, or severe pre-eclampsia or placental insufficiency--should be treated with prophylactic doses of heparin and a baby aspirin during the next pregnancy. Several clinical trials have indicated that the combination of heparin and aspirin is likely preferable to aspirin alone, although some women do have successful pregnancies on aspirin alone. These pregnancies should be considered high risk, with appropriate fetal monitoring, including ultrasounds to monitor growth and placental development, and biophysical profiles, usually from the 26th week onwards. Many of these babies can be rescued by early C-section when there are signs of severe placental insufficiency. There is no consensus on whether treatment is indicated for the woman with lupus who has antiphospholipid antibodies in her first pregnancy. Many authorities in the field would use a baby aspirin in this situation.
An equal, if not more important risk is the risk of preterm birth. Preterm birth in lupus is usually not due to antiphospholipid antibodies, but due to pre-eclampsia and premature rupture of membranes. Risk factors for preterm birth in general include active lupus, high dose prednisone, and renal disease. Maternal hypertension in the second trimester is a good predictor. Overzealous treatment of maternal blood pressure could reduce placental blood flow, and is not recommended. We have not found any risk factors that predict premature rupture of membranes. In addition to being preterm, the baby is also at risk for intrauterine growth retardation (IUGR). We have not found a clinical variable that is predictive of IUGR. In fact, lupus activity, prednisone, and antiphospholipid antibodies are not predictive of IUGR. The best predictor using ultrasound monitoring is an abdominal circumference below the 10th percentile and an estimated fetal weight below the 50th percentile.The most important maternal risk, that of a lupus flare, is actually the most controversial. In prospective studies at both Hopkins and in London, the risk of flare is greater in a pregnant than a non-pregnant woman. However, other centers have not confirmed this. There may be differences in patient selection that account for the different findings. We have found that the hormone prolactin, which rises during pregnancy, is associated with lupus activity during pregnancy. Likely other hormonal influences, especially estrogen, changes in cytokines are involved as well, although these have not been studied. We have found that the type of organ system involvement is different in pregnant vs. non-pregnant patients. In pregnancy we have found an excess of renal and hematologic flares, and fewer arthritis flares.
Some of the risk to the mother is not directly due to lupus. In a case-control study we found that women with lupus were more likely to have multiple complications of pregnancy, including diabetes, urinary tract infections, and pre-eclampsia. For this reason, referral to a high-risk obstetrician is always appropriate. Women on prednisone were more likely to have hypertension and diabetes, as would be expected. The physician caring for a woman with lupus who wishes to become pregnant must review her medications. Prednisone is largely metabolized by the placenta, and is unlikely to cause any fetal malformations, but will increase the risk of diabetes and hypertension in the mother. Some immunosuppressives, such as imuran (azathioprine) have been continued during lupus pregnancy when necessary to control maternal lupus. Cyclophosphamide should never be used during pregnancy because of the high risk of important birth defects. Because of potential teratogenicity, Coumadin should be switched to heparin as soon as the woman knows she is pregnant. ACE-inhibitors, because of effects on fetal kidney development, should be stopped as soon as the woman knows she is pregnant. NSAIDs are usually allowed during the first trimester only, because of potential adverse effects on the fetal ductus arteriosus. Plaquenil (hydroxychloroquine) has a good safety record in lupus pregnancy, and is usually continued if needed to control maternal lupus.Lupus pregnancy should be timed to coincide with a period of good disease control if at all possible. It does not make sense to taper medication simply because a woman desires pregnancy, because of the likelihood of inducing a flare if medications are reduced too low. General screening tests should include the antiphospholipid antibodies, and also anti-Ro and anti-La. A woman who is positive for these antibodies is at increased risk of congenital heart block in the baby, and monitoring of the fetal cardiac conduction system by 4-chamber fetal cardiac echo should be instituted. We generally monitor the mother monthly during pregnancy and obviously more often if disease activity warrants it. Laboratory monitoring done monthly includes the complete blood count, creatinine, liver function tests, urinalysis, and a 24 hour urine for creatinine clearance and total protein. It is controversial whether serologic tests are helpful during pregnancy. In normal pregnancy the C3 and C4 should rise.We are lucky to have a long-term collaboration between our high-risk obstetricians and the Lupus Center at Hopkins that has allowed not only for superb clinical care of the mothers and babies, but also for the prospective database that has led to the studies summarized above. For nearly all mothers, a happy outcome is possible, but we must not forget that we have had one maternal death in our 150 pregnancies and that 7% of the pregnancies are characterized by a severe maternal complication.

Answer 10

I hope this helps.

http://www.medicinenet.com/script/main/art.asp?articlekey=55334