What You Ought to Know About Lupus In Pregnancy

Systemic Lupus Erythematosus or simply Lupus is an autoimmune disease with multi-organ involvement. If you or someone you know have lupus and is planning to or got pregnant, then this article is for you. Keeping the diagnosis part aside, in this article we will talk about how lupus and pregnancy affect each other, and also the treatment of lupus in pregnancy.

Lupus And Pregnancy – How One Affects The Other

Individuals suffering from lupus having high disease activity or a flare can have a negative impact on pregnancy. Multiple studies done had found the following effects Lupus can have on Pregnancy:

• Although a multi-system disease, the fertility rate in both males and females remains normal.
• The rate of fetal loss is increased by two to three folds in females with Lupus
• The fetal mortality rate is higher in individuals with lupus having high disease activity
• Preterm Birth Occurs in approximately one-third of individuals and is also the most common effect of lupus on pregnancy
• The incidence of Preeclampsia is higher in individuals with Lupus. Preeclampsia is a condition that occurs in pregnancy, usually after 20 weeks, and is characterized by high blood pressure and damage to other organs (mainly kidneys and liver).

Now that we know the effects of lupus on pregnancy, let us learn how getting pregnant can affect the disease activity of lupus. The one thing Pregnancy does to Lupus is that it increases the risk of a flare of Lupus by as much as 25-65%. The chances of flare increase if the disease activity at the time of conception is high or if lupus has involved the kidneys (lupus nephritis).

Treatment of Lupus In Pregnancy

We will be discussing the treatment in the following three parts:

• Before Pregnancy:
• The best policy is that individuals with Lupus must go for a planned pregnancy. This is because many drugs like Mycophenolate, Cyclophosphamide, Cyclosporin, Tacrolimus, Rituximab, and Methotrexate used to treat the condition have a teratogenic effect and can lead to birth defects and disabilities in the child. These medications are to be stopped before conception under a physicians’ supervision. However, in case someone with Lupus gets pregnant while on such teratogenic medications, they must consult a physician and obstetrician to decide whether the pregnancy is to be continued or not, for the greater benefit of the unborn child.
• During Pregnancy:
• Suppression of disease activity can be achieved by the use of injectable glucocorticoids or steroids.
• During active disease, Hydroxychloroquine along with an oral steroid (prednisone or prednisolone) at the lowest possible dose for the shortest duration can be used
• Azathioprine is a Category D drug, which means it is teratogenic, but benefits might outweigh the risks in certain situations, can be used if the above treatment doesn’t suppress the disease, for the benefit of the mother. However, the use of it might warrant termination of pregnancy as well.
• After Pregnancy:
• Breastfeeding can be done after pregnancy and drugs like azathioprine, hydroxychloroquine and steroids can be used to treat the condition as there is limited transfer of those drugs in breastmilk.

Although Lupus carries a risk of adverse pregnancy outcomes, with the help of a multidisciplinary team and a planned pregnancy, the outcomes have improved drastically. If you have lupus and planning to or got pregnant, immediately visit your physicians, so that further management for a safe pregnancy can be achieved.