Lupus and Pregnancy: What Expectant Parents Should Know
Systemic lupus erythematosus (SLE), often referred to simply as lupus, is a chronic autoimmune disease in which the immune system mistakenly attacks healthy tissues and organs. While there is no cure, many people with lupus can manage their symptoms and live full lives. For those considering pregnancy, it’s important to understand how lupus may affect both parent and baby—and how specialized care can help ensure the best outcomes.
How Lupus Affects the Body
Lupus can impact many organ systems, including the:
- Kidneys
- Joints, muscles, and skin
- Blood and immune system
- Brain
- Heart
- Lungs
People with lupus often experience “flares” (times when symptoms worsen) followed by remission (times when symptoms improve or disappear). Lupus is more common in women, especially young adults.
Lupus and Pregnancy Risks
Pregnancy with lupus is considered high risk because of the potential for complications, including:
- Pregnancy loss
- Preeclampsia (dangerously high blood pressure)
- Fetal growth restriction (when the baby is smaller than expected)
- Preterm birth
In rare cases, lupus antibodies can affect the baby, leading to a condition called neonatal lupus erythematosus (NLE). This may cause skin lesions, anemia, or heart problems. While most effects resolve after birth, a complication called congenital heart block can leave permanent scarring and may be life-threatening.
Managing Pregnancy with Lupus
If you are pregnant and living with lupus, your care team will take extra precautions, including:
- Regular blood tests and monitoring throughout pregnancy.
- Blood pressure checks at every visit.
- Ultrasound exams in the third trimester to monitor growth and well-being.
Your healthcare provider will also review your medications. Some lupus medications are safe to continue during pregnancy, while others should be avoided. For many patients, hydroxychloroquine is recommended, even in remission, as it can reduce complications. Low-dose aspirin starting at 12 weeks may also be suggested to lower the risk of preeclampsia.
Can Pregnancy Trigger Lupus Flares?
Pregnancy may increase the risk of lupus-related complications, such as kidney problems, blood clots, or nervous system issues. Most flares that occur during pregnancy are mild, but about 15% to 30% are severe and may require additional treatment.
Preparing for Pregnancy with Lupus
Planning is key. If you are considering pregnancy:
- Schedule a pre-pregnancy visit with both your rheumatologist and a maternal-fetal medicine (MFM) specialist.
- Review your current medications with your doctors before trying to conceive. Do not stop or switch treatments without medical guidance.
- Consider timing—many experts recommend waiting until lupus symptoms have been under control for at least six months before becoming pregnant.
- Talk with your provider about safe and reversible birth control options if you need to delay pregnancy.
