Understanding Lupus during Pregnancy

Reviewed by James Brann, MD
A woman who has lupus can still have a normal pregnancy. However, it’s more common that a pregnant woman with lupus will have additional problems during her pregnancy.
If you have lupus, it’s important that you talk with your doctors before getting pregnant, and regularly have checkups to try to lessen your chances of problems. You don’t want to try to get pregnant before you’ve had your lupus under control for a minimum of six months.

Before getting pregnant

Before getting pregnant, get with your doctor. You’ll need to see your obstetrician. This is the doctor that cares for you during pregnancy. You also need to see your rheumatologist, the doctor in charge of your lupus, and your primary care physician.

These doctors will make sure that any of the medications you’re put on during pregnancy are safe. They’ll also want to perform some testing to make sure your lupus is well under control, and there won’t be any problems for you or your child during your pregnancy.

Certain lupus medicines can be dangerous for your baby, and lead to serious problems. You need to make sure you stop taking these types of medicines before you try to get pregnant:

  • Cyclophosphamide, under the brand name of Cytoxan - Stop taking this at least one month before attempting to get pregnant
  • Mycophenolate mofetil, under the brand names Myfortic or CellCept - You need to stop taking this at least one month before attempting to get pregnant
  • Methotrexate, under the brand names Trexall or Rheumatrex - You need to stop taking this between 1-3 months before attempting to get pregnant


If you end up getting pregnant while on any of the above medicines, make sure you call your doctor immediately. They’ll be able to help determine whether you need to switch or stop any of the other medicines you’re on, too. They’ll also be able to suggest additional treatments, if necessary.

Pregnancy and lupus symptoms

For some women, pregnancy may affect their lupus symptoms. In certain cases, they find their lupus symptoms get worse. It’s not known for sure, though, whether pregnancy is causing the symptoms to worsen during pregnancy.

There are normal pregnancy symptoms that are also similar to symptoms of lupus. They include:

Lupus and pregnancy

Having lupus also increases your chance of these things:
  • Delivering a premature baby (born before week 37 of pregnancy)
  • Preeclampsia - This serious condition includes high blood pressure and an excess of protein in your urine. It can impact your child’s growth.
  • Losing your baby after week 10 of pregnancy
  • Having a smaller than normal baby


Your lupus may raise your child’s risk of these things:
  • Learning disabilities
  • Neonatal lupus - This may occur when the child’s mother has certain antibodies, or proteins, in the blood. Not everyone who has lupus also has these antibodies, but your doctor can do a blood test on you to find out. It may lead to your baby having heart problems.


Medicines and pregnancy

Some lupus medicines do run the risk of injuring an unborn child. Other medicines, however, are safe during pregnancy but only in certain amounts or at certain times. Safe medicines include:
  • Steroids - Medicines like prednisone are fairly safe during pregnancy, as long as you use low doses. These are not the same types of steroids that an athlete builds muscle with.
  • NSAIDs - These types of medicines include ibuprofen (Motrin or Advil), naproxen (Aleve) and aspirin. While they can sometimes be used safely during pregnancy, sometimes they cannot.


There are also other safe medicines out there. Your doctors will be able to help you figure out how to treat your lupus symptoms the best way so that you don’t hurt your child.

Make sure you talk with your doctors about each medicine you take, and follow any directions they give you. Don’t begin taking new medicines, herbal drugs or supplements without talking to your doctors first.

  • Joint pain
  • Tiredness
  • Feet, ankle or hand swelling
  • Pain or numbness in hands
  • Breathing trouble
  • Skin darkening on the face


For some women with lupus, they say their symptoms worsen after delivery. This seems to be more common when the women had symptoms already when they got pregnant, rather than women with symptoms that were under control.

Breastfeeding

If you have lupus, you can still breastfeed. You need to make sure you stay away from certain medicines, though. Some lupus medicines could get in your breast milk and then harm your baby.

If you do want to breastfeed, make sure you talk to your doctor. They’ll be able to tell you which medicines are safe and which ones you want to avoid. The majority of the medicines that won’t be safe during pregnancy also won’t be safe while your breastfeed. If you do need these medicines to help control your lupus, there’s a chance you may need to stop breastfeeding.


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