Pregnancy and Lupus

If you have lupus, you can bear children, but you need to be prepared so that you and your baby are healthy. Your pregnancy is considered high-risk because lupus can cause problems.1

Planning in advance

When you decide to have a baby, talk with your rheumatologist and with an obstetrician who specializes in high-risk pregnancies. Plan for delivery at a hospital with a Neonatal Intensive Care Unit and other facilities to provide any special care that you or your baby may need.2

Your medical team will help you make sure that your disease is under control for at least 6 months before you become pregnant. Your doctors will pay extra attention to controlling kidney disease because pregnancy puts added stress on your kidneys. They may adjust your medications if some of the drugs are not considered safe during pregnancy or for your baby.2

Conditions that increase the risk of problems

If you have lupus, you’re more likely to have problems during pregnancy if you have these conditions:1-3

  • High blood pressure
  • Kidney disease
  • Lung disease
  • Heart failure
  • History of preeclampsia – sudden high blood pressure during pregnancy in a previously normal woman
  • Stroke
  • Certain autoantibodies in the blood
  • Active lupus
  • Certain medications
  • First-time pregnancy

Possible problems during pregnancy

Women with lupus are more likely to have these problems during pregnancy than women without lupus:1,3-4

  • Lupus flares that may damage the mother’s organs
  • Preeclampsia – Symptoms may include sudden weight gain, swelling of the hands and face, blurred vision, dizziness, or stomach pain
  • Eclampsia – Seizures caused by damage from preeclampsia can lead to life-threatening conditions
  • High blood pressure
  • Diabetes
  • Kidney problems
  • Infection
  • Blood clot
  • Excessive bleeding

How lupus affects the baby

Most women with lupus have healthy babies. But some risks to the baby are more common in women with lupus than in women without lupus:2,4

  • Miscarriages – in about 1 out of 5 pregnancies
  • Preterm delivery – in about 1 out of 3 pregnancies
  • Low birth weight
  • Neonatal lupus – in about 15 to 20 percent of babies when the mother has certain autoantibodies. A rash and abnormal blood counts usually go away in 6 to 8 months.
  • Complete heart block – in about 2 percent of babies when the mother has certain autoantibodies. The baby most often needs a permanent pacemaker.

Care during pregnancy

Women with lupus who are pregnant should see the rheumatologist at least once a trimester and the obstetrician for regular follow-ups. During visits, your doctor will check the results of lab tests and review your medications.4

If you have certain autoantibodies, usually you’ll be treated with low-dose aspirin. If you also have pregnancy problems or a history of blood clots, an anticoagulant will generally be prescribed.4

If you have autoantibodies that are linked with the risk of complete heart block, you will be monitored with a series of fetal echocardiograms during part of your pregnancy.4

Lupus and breastfeeding

Most women with lupus can breastfeed their babies. The American Academy of Pediatrics (AAP) recommends breastfeeding because it provides better nutrition and improved immunity in your baby. AAP says that breastfeeding also helps your health. It lowers your risk of type 2 diabetes and of breast and ovarian cancer.5 Women with lupus may face some problems with breastfeeding:2

  • A premature baby may not be strong enough to nurse. You may use a breast pump to express milk and feed it to your baby in a bottle.
  • You may not be able to produce enough milk if your baby was premature or if you are taking steroid medication for lupus.
  • Some medications can go through breast milk to your baby. Your doctor will advise you whether or not your medications are safe for your baby.

Resources

For more information about pregnancy, breastfeeding and lupus, call the Office of Women’s Health Helpline at 1-800-994-9662 or visit the Lupus Foundation of America.

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