Yes, however it is important for women with lupus to consult their rheumatologist prior to getting pregnant. In addition, having a pre-conception consultation with a high risk doctor prior to pregnancy is important for women with significant chronic diseases, such as lupus.
Women with lupus are at higher risk for pregnancy complications, including problems with fetal growth, high blood pressure in pregnancy (pre-eclampsia), preterm delivery and stillbirth.
Most babies born to women with lupus are healthy. A small percent of women with lupus, however, have certain antibodies that can affect the fetal heart and rarely lead to a serious condition known as complete heart block. If these antibodies are present, your doctor will monitor the heart rate on the fetus more closely. Also, a small percent of babies can be born with neonatal lupus due to certain antibodies from the Mom’s blood still being present in the baby after birth. Babies with neonatal lupus may have abnormal blood counts or a rash, but this typically resolves within a couple of weeks or months as the antibodies clear the baby’s system. Because of these known risks, if you have Lupus it is important to have your pregnancy followed more closely.
Many women with lupus are worried about experiencing a flare during their pregnancy. Although everyone is different, if your disease has been well controlled for six or more months, you are at lower risk for pregnancy complications or flares. There are some “normal” symptoms of pregnancy, such as aching joints, hair changes, rashes, swelling of the legs, and a feeling of warmth that could be confused with a flare, but you should check in with your rheumatologist and obstetrician if these symptoms occur.
Some of the common medicines used to treat Lupus are unsafe for your developing baby and may also be unsafe to use while you breastfeed. Some medicines such as cyclophosphamide (Cytoxan) can decrease your chance in becoming pregnant. If you have received Cytoxan in the past, you should talk with your doctor.
Medicines that are considered generally safe include:
- hydroxychloroquine (plaquenil)
- and acetomenophen (Tylenol)
Unsafe medications include:
- mycophenolate mofetil (CellCept)
- coumadin (warfarin)
- ACE inhibitors (Lisinopril, Ramipril, etc)
All medicines and supplements should only be used with close monitoring from your physician. Talk to your doctor about your medicines before you become pregnant.
Preconception consultation with a high-risk obstetrician can help develop a plan for the optimal care team for you during pregnancy, labor and the postpartum period. Close monitoring with more frequent prenatal appointments are very important if you have a chronic disease, like Lupus, as many common problems can be prevented and those found early can be easier to treat.
Louise E. Wilkins-Haug, MD, PhD, is the Division Director of Maternal Fetal Medicine and Reproductive Genetics at Brigham and Women’s Hospital
Sarah Elizabeth Little, MD, MPH, is a Maternal-Fetal Medicine specialist in the Department of Obstetrics and Gynecology at Brigham and Women’s Hospital.