Lupus Pregnancy

What is Lupus Pregnancy?

Systematic Lupus Erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease that can affect any part of the body. As it is in all autoimmune diseases, a person’s immune system is unable to differentiate bacteria, germs, viruses, and other pathogens from healthy cells and tissues, because of which it starts attacking healthy organs in the body.

Lupus is more common in women, and until recently, if a woman had lupus, pregnancy and safe delivery were out of the question for them. Even though with the disease, there are more risks of complications arising in the pregnancy, SLE and healthy gestation can be managed, with proper care and monitoring.

Another factor that can affect a pregnancy are lupus anticoagulant antibodies, which attack an essential component of cell membranes, called phospholipids, and can lead to serious pregnancy complications and even pregnancy loss.

Symptoms to Look Out for

Symptoms of lupus can range from mild to severe and generally have a tendency to appear and disappear. Many times, distinguishing between the symptoms of pregnancy and an SLE flare becomes quite challenging. This is because the many changes in bodily functions that take place in pregnancy can overlap with signs of the disease. During pregnancy, lupus flares can lead to:

• Fatigue
• Body pain
• Fever
• Butterfly-shaped redness across the cheeks and nose
• Hair loss in patches
• Pain or swelling of the joints

Symptoms Common for Lupus and Pregnancy

In cases where lupus has affected certain major organs, people may also get symptoms like pain in the chest or problems with breathing.

Symptoms that people may display, which can be both, discomfort caused by pregnancy and a lupus flare, include:

• Swelling in the joints. Pregnancy tends to loosen the ligaments around the joints, which can lead to swelling.
• Pain in the joints or in the lower back.
• Swollen ankles, hands, or feet, which in pregnancy, are caused by the body’s increased fluid retention.
• Redness on the face, which is also called the pregnancy blush, is a result of the increased blood flow to the skin.
• Hair loss.
• Fatigue.
• Shortness of breath. During pregnancy, this is caused by the shifting of the diaphragm, which moves upwards to make room for a baby.

It is crucial for proper management and issue treatment in pregnancy and lupus to remain in regular contact with the doctor and if any of the mentioned symptoms can be noticed, it should immediately be reported to the doctor. Even if it is a flare of lupus, pregnancy risks and the flare will be easier to treat if detected early, which also lowers the risk of further complications for the mother and baby.

Symptoms of Preeclampsia

Preeclampsia is another complication in pregnancy with SLE, and treatment, if provided early on, can make a huge difference. Following are some common symptoms of preeclampsia that can be a major cause for concern and should be treated as a medical emergency:

• Vision becoming blurry or sudden changes in vision.
• Severe headaches.
• Severe pain in the upper abdomen, which is usually located somewhere under the ribs on the right.
• Severe shortness of breath or breathing problems.

Symptoms of Lupus Anticoagulants

In a pregnancy, lupus anticoagulants may be present without symptoms, forming no unnecessary blood clots. But if blood clots are being formed, one will be able to notice the following symptoms, based on the clot’s location.

In the limbs (arms or legs):

• Swelling
• Redness or discolouration
• Difficulty in breathing
• Pain or numbness

 In the heart or lungs area:

• Pain in the chest
• Thigh pain
• Diarrhoea
• Bloody stools
• Fever
• Nausea

For a safe pregnancy, treatment of lupus anticoagulants and resultant blood clots is crucial.

Lupus and Pregnancy: Complications that May Arise

While lupus can lead to complications at any point in a pregnancy, SLE flares are most common during the first trimester, and can potentially increase the risk of complications, like:

• Miscarriage
• Preterm delivery
• Premature rupture of the amniotic sac membrane
• Preeclampsia, a serious high blood pressure problem
• Intrauterine growth restriction
• Miscarriage or stillbirth
• Chances of developing infections
• Low platelet count
• Formation of unnecessary blood clots
• Neonatal lupus in the baby

The chances of pregnancy loss depend on the severity of lupus at the time of conception or in cases where SLE forms during pregnancy.

In pregnancy, a lupus anticoagulant test is also crucial, regardless of whether the mother is suffering from lupus or not. It is not necessary for people with SLE or other autoimmune diseases to have lupus anticoagulant antibodies, which may even be present in people with no history of autoimmune issues. Increasing the risk of blood clots in the body, the antibodies can lead to a miscarriage or even multiple miscarriages.

Guidelines for SLE and Pregnancy Management

Ensuring consistent medical care before and during a pregnancy is vital and should be discussed with a medical practitioner in detail before conception. Common guidelines for SLE and pregnancy management include:

Preparing for Pregnancy

Ensure Lupus is Under Control: Avoid conceiving till at least 6 months have passed since the last lupus flare. This is even more important in cases where the mother has lupus-related kidney issues as pregnancy is known for placing extra stress on the kidneys. The healthier the mother is at the time of conception, the better is the chances of a healthy pregnancy.

Review Medication: Before starting the pregnancy, the lupus and lupus anticoagulants treatment must be reviewed. While some lupus medication is safe for pregnant women, others can harm the baby. So, a doctor must stop some medications and switch to others before one gets pregnant. In fact, some medications may need to be discontinued for a period of a few months before one tries for conception.

Find the Right Obstetrician: Lupus presents risks like preterm birth, pregnancy-induced hypertension, etc., which makes it important to find a OB/GYN who has experience with high-risk pregnancies.

During Pregnancy

• Regular Check-Ups: Prenatal check-ups are important for all women, but if they have lupus, the checks become all the more important for proper monitoring of the disease.
• Flares: Many women feel an improvement in their lupus symptoms during pregnancy, but flares are still common for others. Most flares, if they occur, are mild and can be treated effectively by the doctor.
• Hypertensive Complications: A common issue in women who have kidney disease or high blood pressure problems and require immediate medical attention and treatment. Such issues may often even lead to an unplanned delivery of the baby.
• Miscarriage: In pregnancy, treatment of lupus anticoagulants is vital as it may lead to pregnancy loss. Usually, the issue can be dealt with by prescribing a simple blood thinner.

Tips:

• Get enough rest during the night and take breaks during the day as well.
• Eat healthy and avoid excessive weight gain.
• No smoking or drinking alcohol.
• Report any anomalies or unusual symptoms to the doctor immediately.

When to See an OB/GYN?

If any of the aforementioned symptoms are noticed, immediate medical attention must be provided to the expecting mother. Apart from this, regular prenatal checks, screening tests, follow-ups, etc. must be done regularly.