Patient education: Lupus and pregnancy (The Basics)

Can people with lupus have healthy pregnancies? — Yes. It is possible for people with lupus to have healthy pregnancies. But people who have lupus are more likely to have problems during pregnancy than those who don't.

If you have lupus, work closely with your doctors before and during pregnancy to reduce the chance of problems. You should not try to get pregnant until your lupus has been under control for at least 6 months.

What should I do before trying to get pregnant? — It is very important to talk to your doctors before trying to get pregnant. You will need to see an obstetrician (a doctor who takes care of people during pregnancy), your rheumatologist (the doctor who handles your lupus), and your primary care doctor.

Your doctors can make sure that any medicines you take are safe to use during pregnancy. They will also do some tests to make sure your lupus is under control and that you don't have any medical problems that might affect you or the baby during pregnancy.

Some lupus medicines are very dangerous for a developing baby and can cause serious problems, including birth defects. If you take any of these medicines, you will need to work with your doctor to stop them before getting pregnant:

●Mycophenolate mofetil (brand names: CellCept, Myfortic) – You should stop this medicine, or switch to another medicine that is safe during pregnancy, at least 6 months before trying to get pregnant. This is so your doctor can make sure your lupus is under control.

●Cyclophosphamide (sample brand name: Cytoxan) – You should stop this medicine, or switch to another medicine that is safe during pregnancy, at least 3 months before trying to get pregnant. This is so your doctor can make sure your lupus is under control.

●Methotrexate (sample brand names: Rheumatrex, Trexall) – Stop at least 1 month (3 months is even better) before trying to get pregnant.

If you do get pregnant while taking any of these medicines, tell your doctors right away. Your doctors will help you decide whether to stop (or switch) any other medicines you are taking. They might recommend tests to make sure your baby is developing normally.

There are also steps that everyone should take before trying to get pregnant. These include things like taking vitamins and avoiding smoking, alcohol, and certain foods. Your doctor or nurse can talk to you more about general planning for pregnancy.

How will my lupus affect my pregnancy and my baby? — For some people, having lupus increases the risk of:

●Preeclampsia – Preeclampsia is a serious condition that can happen during pregnancy. People with preeclampsia have high blood pressure and too much protein in their urine. The condition can cause problems with the baby's growth.

●Giving birth to a "premature" baby (the baby is born before 37 weeks of pregnancy)

●Having a baby that is smaller than normal

●The fetus dying after 10 weeks of pregnancy (a "fetus" is what a baby is called before it is born)

Having lupus can increase your baby's risk of:

●Having a disease called "neonatal lupus" – This can sometimes happen when the mother has a certain type of antibodies (proteins in the blood). Not everyone with lupus has these antibodies. Your doctor can test your blood for them. Sometimes, neonatal lupus can cause the baby to have heart problems, although this is uncommon.

●Having learning disabilities – There are some studies that show that children of mothers with lupus have a slightly higher risk of learning disabilities.

You can reduce the risk of problems during pregnancy by seeing your doctors often and letting them know if you think anything is wrong. Your doctors will do tests throughout your pregnancy to check for any problems.

How will my medicines affect my pregnancy or my baby? — Some lupus medicines can hurt an unborn baby.

Other medicines are safe to take during pregnancy if needed, but only at certain times or in certain amounts:

●NSAIDs – NSAIDs include medicines such as ibuprofen (sample brand names: Advil, Motrin), naproxen (sample brand name: Aleve), and aspirin. They can safely be used at some times in pregnancy, but not at other times.

●Steroids – These medicines, such as prednisone, are fairly safe in low doses during pregnancy. (These are not the same as the steroids some athletes take illegally.)

There are other safe medicines available, too. Your doctors can help you decide how best to treat your lupus symptoms without hurting your baby.

Talk to your doctors about all the medicines you take and follow their directions carefully. Do not start taking any new medicines, supplements, or herbal drugs without first talking to your doctors.

Will pregnancy affect my lupus symptoms? — It might. Some people with lupus notice that their symptoms get worse during pregnancy. But it is not clear whether pregnancy actually causes symptoms to get worse. If your symptoms are not under control when you get pregnant, they will be more likely to get worse during your pregnancy.

Some normal pregnancy symptoms are similar to lupus symptoms. These include:

●Feeling tired

●Swelling of the hands, feet, or ankles

●Joint pain

●Trouble breathing

●Numbness or pain in the hands

●Darkening of the skin on the face

Some people with lupus notice that their symptoms get worse after they give birth. This is more likely if you had symptoms when you got pregnant than if your symptoms were under control.

Will I be able to breastfeed? — Yes. You can breastfeed if you have lupus. But you will need to avoid certain medicines while you are breastfeeding. That's because some lupus medicines can get into breast milk and harm a baby.

If you want to breastfeed, talk to your doctors. They can tell you which medicines you can take and which ones to avoid. Most of the medicines that aren't safe to take during pregnancy also aren't safe during breastfeeding. If you need these medicines to control your lupus, you might need to stop breastfeeding.

More on this topic

Patient education: Lupus (The Basics)
Patient education: How to plan and prepare for a healthy pregnancy (The Basics)
Patient education: Preeclampsia (The Basics)
Patient education: Preterm labor (The Basics)
Patient education: Deciding to breastfeed (The Basics)

Patient education: Systemic lupus erythematosus and pregnancy (Beyond the Basics)
Patient education: Systemic lupus erythematosus (Beyond the Basics)
Patient education: Preeclampsia (Beyond the Basics)
Patient education: Preterm labor (Beyond the Basics)