Pregnancy complications

• Pregnancy complications may need special medical care.
• Common problems include anemia, diabetes and bleeding.
• Ask your provider about the signs of serious complications.

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Lupus, also called systemic lupus erythematosus or SLE, is an autoimmune disorder that can cause health problems during pregnancy. Autoimmune disorders are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue just about anywhere in the body by mistake.

Lupus and other autoimmune disorders can cause swelling, pain and sometimes organ damage. Lupus also can affect joints, skin, kidneys, lungs and blood vessels.

Lupus affects more than 160,000 people in this country. Women are more likely to have autoimmune disorders like lupus than men. It often develops in women of childbearing age (16 to 44) and can affect a pregnancy. Fortunately, with the right care, you can still have a healthy pregnancy if you have lupus.

What causes lupus?
We’re not sure what causes lupus. Your genes may play role, along with other things, like viruses. Genes are the part of your cells that stores instructions for the way your body grows and works.

What are the symptoms of lupus?
Symptoms often include:

• Swollen or painful joints
• Muscle pain
• Skin rash – A red, butterfly-shaped rash across the nose and cheeks is common.
• Fever
• Tiredness
• Chest pain when taking a deep breath

The symptoms can be mild to severe with periods of remission (few or no symptoms) and flares (many or intense symptoms).

What problems can lupus cause during pregnancy?
Lupus may increase the risk of these problems during pregnancy:

• Lupus flares. You may experience flares during pregnancy or in the first few months after giving birth. If your lupus is in remission or under good control, you’re less likely to have flares.
• Preeclampsia. This is a certain kind of high blood pressure that only pregnant women can get.
• Premature birth. This is birth that happens too early, before 37 completed weeks of pregnancy.
• Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
• Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.

If you’ve been in remission or had your condition under good control for at least 6 months before pregnancy, you’re less likely to have complications. Talk with your health care provider before getting pregnant about the safest time for pregnancy.

What problems can lupus cause in your baby?
Most babies of mothers with lupus are healthy. However, some babies may face health risks, like:

• Premature birth. About 3 in 10 babies (30 percent) of mothers with lupus are born prematurely. Premature babies may need to stay in the hospital longer or have more health problems than babies born full term (39 to 41 weeks of pregnancy).
• Neonatal lupus. About 3 in 100 babies (3 percent) are born with this temporary form of lupus. This condition causes a rash and blood problems but usually clear up by 6 months of age. However, up to half of these babies have a heart problem called heart block. This is a condition that causes a slow heartbeat. Heart block is often permanent. Some babies need a pacemaker to help make their heart beat regularly.

How do you know if you have lupus?
If you’re experiencing the symptoms of lupus, talk to your provider. To find out if you have lupus, your provider looks at your symptoms, your health history and the results of some tests, including:

• A physical exam
• Blood tests to look for certain antibodies that often are seen in people with lupus
• Urine tests to see how well your kidneys are working
• A biopsy, testing a small sample of tissue, skin or kidneys to check for inflammation and damage

How is lupus treated?
Lupus can be treated with many different medicines. If you’re being treated for lupus, talk to your provider about the medicines you’re taking before you get pregnant. Your provider may want to change your medicine while you’re pregnant.

Medicines used to treat lupus include:

• Anti-inflammatories. Aspirin, ibuprofen (Motrine® or Advil®) and naproxen (Aleve®) can help relieve joint pain and fever. Talk to your provider to find out if you can take these during pregnancy.
• Malaria medicines. Hydoxychloroquine (Plaquenil®) and other malaria medicines can help prevent flares and relieve joint pain, tiredness and other symptoms. These medicines are safe to use during pregnancy.
• Corticosteroids. Prednisone (Sterapred®), methylprednisolone (Medtrol®) and related medicines can help reduce inflammation and relieve symptoms. These medicines can only be used for a short time because of side effects. They are fairly safe to use during pregnancy, but they may increase the risk of cleft palate. This is a birth defect in which the roof of a baby’s mouth doesn’t form completely and has an opening in it.
• Immunosuppressives. Cyclophosphamide (Cytoxan®) and methotrexate (Folex®, Mexate®, Rheumatrex®) are cancer-fighting medicines. Azathioprine (Imuran®) and mycophenolate mofetil (CellCept®) are medicines used in organ transplant patients to help prevent organ rejection. Your provider may treat you with immunosuppressive medicines if you have serious lupus symptoms. These medicines may cause serious side effects, such as increased risk of serious infection. They’re not safe take if you’re pregnant. Both cyclophosphamide and methotrexate are associated with birth defects. We don’t know how safe azathioprine and mycophenolate mofetil are during pregnancy.

Do you need special medical care during pregnancy?
Yes. Your provider closely monitors your pregnancy so that any lupus flares or problems can be treated quickly. In general, you should be cared for by:

• High-risk obstetrician, a doctor who specializes in taking care of women with serious pregnancy complications
• Rheumatologist, a doctor who specializes in disorders having to do with inflammation or pain in muscles and joints

Most likely your baby will be born healthy, but you may want to plan to give birth in a hospital that is equipped to care for premature or sick babies.

For more information:

• Centers for Disease Control and Prevention (CDC)
• National Institute for Arthritis and Musculoskeletal and Skin Diseases