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Can you get pregnant with lupus?
Le lupus is a chronic autoimmune disease that primarily affects women of childbearing age. Also, the question of the possibility of pregnancy with lupus arises.
Fortunately, and apart from any pathology affecting fertility, lupus is a priori compatible with pregnancy. However, as lupus progresses in flare-ups and that it may require drugs affecting fertility or the health of the fetus, lupus and pregnancy should be considered with caution.
In general, lupus specialists agree that pregnancy in a woman with lupus is a so-called “risky” pregnancy, which requires special monitoring. The type of lupus (cutaneous or systemic, active or inactive …) will also have its influence on the risks and possible complications of a lupus pregnancy. Hence the interest of continuing to be followed by a lupus specialist throughout pregnancy, in parallel with the classic gynecological follow-up.
Note that in a few rare cases, when lupus has caused serious damage (severe kidney damage, heart valve damage, pulmonary hypertension, etc.), pregnancy will be discouraged as it is considered too dangerous for the patient.
When to get pregnant with lupus?
The question may seem strange, and yet it is indeed advisable to planning a pregnancy when you have lupus.
It is often recommended to achieve that the disease is under control, apart from a relapse episode, and stabilized, to consider pregnancy. We advise you to wait a period of remission of at least six months, without relapse, with lupus under control. Because a flare-up of lupus during pregnancy increases the risk of complications, such as premature delivery, miscarriage, pre-eclampsia, or low birth weight.
If you are taking drugs for lupus that affect fertility or increase the risk of a fetal malformation, you should stop them three to six months before the start of the pregnancy plan, then change the treatment and check that it is suitable.
What follow-up for a lupus pregnancy?
Monitoring the pregnancy of a woman with lupus is more medicalized even that of an average woman. In the presence of lupus, pregnancy monitoring is carried out at the same time by a referring lupus doctor, most often a rheumatologist, and by an obstetrician-gynecologist familiar to the management of a lupus pregnancy. These consultations are initially monthly, but can take place every week at the end of pregnancy.
Before conception and / or at the start of pregnancy, blood and urine tests are performed in order to monitor the kidney and liver functions of the mother-to-be, and to detect the presence of antibodies and anticoagulants that may affect the proper course. pregnancy or the health of the future baby. These blood tests are sometimes continued until delivery, depending on the patient’s lupus.
If certain antibodies are detected in the blood, an ultrasound and fetal doppler may be performed, to detect possible heart problems related to lupus in the fetus. These tests are in addition to those carried out in all pregnancies, which are the three compulsory ultrasounds and any blood tests (HCG, toxoplasmosis, rhesus incompatibility…).
In a pregnant woman with lupus, pregnancy monitoring will also consist of ensuring that the physiological changes observed (skin rashes, joint pain or swelling, hair loss, edema, etc.) result from the pregnancy and not from an outbreak of lupus .
What are the risks of pregnancy with lupus?
Well taken care of, a lupus pregnancy Usually goes without complications, since it is estimated that 80% of these pregnancies occur without major events. However, it should be kept in mind thatlupus during pregnancy increases the risk of miscarriage, pre-eclampsia and preterm delivery. Cesarean sections are also more frequent, because it is sometimes necessary to induce delivery urgently.
In about 20% of cases, pregnancy also leads to a flare-up of the disease.
Lupus pregnancy also involves health risks for the unborn baby, including that of contracting neonatal lupus, or heart complications. But these are rare or even exceptional complications, which will in any case be identified during medical monitoring, and closely monitored.
Where to give birth when you are pregnant with lupus?
Because of the risks associated with lupus, pregnant women with lupus are sometimes advised togive birth in a level II or III maternity hospital, so that specialized care can be provided immediately to mother and baby when needed. But again, everything will depend on the history of the mother-to-be with lupus, and the progress of the pregnancy. Childbirth can be initiated for more comfort, to ensure the presence of specialized medical teams on the day. Unless special conditions, vaginal delivery is possible during a lupus pregnancy, just like the installation of an epidural (in the latter case, be careful not to take aspirin the days preceding).
Can you breastfeed with lupus?
Breastfeeding is a priori possible with lupus, provided that the prescribed drugs are compatible with breastfeeding. This is why it is essential to” addressing the issue of breastfeeding upstream with his specialist, to adapt treatments accordingly.
Sources and additional information:
- https://www.lupusplus.com
- https://www.lupus.be
- http://lupusbasic.com/grossesse-et-lupus-systemique/
- Document from the University Hospital of Thiers