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15 Ways To Manage Lupus During Pregnancy

Lupus is a chronic disease that happens when the body’s immune system attacks tissues and organs. According to the Lupus Foundation of America, about 1.5 million people living in the United States suffer from lupus - 90 percent of them are women and this includes people who could be pregnant.

Although lupus can lead to symptoms such as inflammation, swelling and damage to joints, skin, blood, heart, lungs and kidneys, the truth is that people can live a happy productive life with this auto immune disease. When they have lupus and are pregnant or are thinking of becoming pregnant, there are factors to consider.

Lupus doesn’t reduce the chances of getting pregnant; however, all lupus pregnancies are classified as high risk. Why? Well, this is because research shows that lupus can complicate pregnancy by increasing the risk of premature delivery, preeclampsia and miscarriage. The disease has also been linked to heart problems in babies.

Thanks to research, we have come a long way when it comes to the subject of lupus during pregnancy. Lupus is a disease that strikes women in their childbearing years and back in the 1970’s; when we knew less about the condition, women were told not to get pregnant. Today doctors take a different approach by guiding mothers-to-be on how to take care of themselves and their unborn babies when lupus is present. As it turns out, for most women with the disease, successful pregnancy is possible. Recent studies show that only about 50 percent of women who have lupus experience pregnancy complications.

If someone has lupus and is thinking of starting a family or is already pregnant they can manage the disease several different ways.

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15 Assemble Medical Support

Before even getting pregnant, a woman who suffers from lupus should think about assembling a team of experts to help her assess her current health status and monitor her wellbeing during the pregnancy. Anyone with lupus should have a rheumatologist. This is a specialist that focuses on lupus and other auto immune diseases. A perinatologist or high-risk obstetrician should also be part of the woman’s medical support team. Some women with lupus have been known to have a pediatric cardiologist involved as well.

Preconception discussions with a medical team not only address any fears that the mother might have, but also gives doctors an idea of how lupus has affected her in the past. Some pregnancies may require lupus treatment early on and those treatments often counteract more serious complications later on in the pregnancy. Since the risk of complications are greater when a woman has a lupus flare-up, keeping the lines of communication open with a healthcare team, at all stages of the pregnancy is important.

14 Get A Risk Assessment

Doctor caring about patient lying in hospital

Every case of lupus is different and this stands true for women who are pregnant. While the disease doesn’t seem to increase the risk of miscarriages in the first trimester, there is a higher risk of miscarriage later on in pregnancy. Stillbirth can also be a risk. These problems crop up due to anti-phospholipid and anti-cardiolipin antibodies. Research indicates that about 33 percent of women who suffer from lupus have these antibodies. The issue is that the antibodies can lead to blood clots. Now if a woman has lupus and is considering pregnancy, she can ask her doctor about these antibodies. The doctor just might suggest a blood test that can check for the presence of such antibodies.

Blood clots are a scary thought since they can impact a baby’s food and oxygen supply. Clots can also slow down a baby’s growth rate. If someone has an increased risk of blood clots it doesn’t necessarily mean they should avoid getting pregnant. Doctors often prescribe a blood thinner, such as a low-dose aspirin or heparin to treat high-risk patients.

There are tests for other antibodies that could pose a direct threat to the baby. For instance, some antibodies have been associated with an increased risk of babies having a congenital heart block.

13 Watch For Flare Signs

While lupus flare-ups can occur during pregnancy, many women with lupus have reported that their symptoms actually improve while they are carrying a baby. Studies show that if you get pregnant following a six-month remission period you are less likely to experience a lupus flare.

One of the difficulties with lupus flare-ups and pregnancy is that the flare can be similar to symptoms of pregnancy. For example, joint swelling, facial rashes and fluid retention are all associated with pregnancy, but they are also linked to lupus. When a woman with lupus is pregnant and has any of these symptoms she can’t assume the disease or the pregnancy is the cause. It is best to talk to a doctor and let him or her determine whether this is a lupus flare-up or the normal signs of pregnancy.

There could be some signs of the disease that are more obvious to a woman and those should be reported to a doctor immediately as well.

12 Plan Around Remission Period

Actress Selena Gomez arrives for the "Louis Vuitton Series 3" exhibition gala opening in London, Britain September 20, 2015. REUTERS/Luke MacGregor

In some lupus cases the disease will flare up for periods of time and then is will become inactive, which is called “remission”. This cycle may occur a few times or it could happen regularly. While there is no official definition of lupus remission most sufferers understand that it can mean that they feel as if their health has gone back to normal or that flare-ups have calmed down considerably. In some situations, remissions have a pattern to them. For example, one person may find they experience remissions more in the spring or fall, while others may notice they feel better only when they avoid certain foods or activities.

When a woman experiences regular remissions, she might want to consider getting pregnant during a remission. It isn’t always easy to plan a pregnancy; however, in cases where health is a factor, it can be necessary to try. When lupus is not active, far fewer complications are likely to arise. Having said all this, a complete health exam should be carried out before executing such a plan.

11 Alter Medications

Close-up of a person's hands holding a bottle of pills

Anyone who is pregnant or thinking about becoming pregnant needs to talk with their doctor about medications that they are taking or thinking about taking. This includes prescription and over-the-counter medications, as well as any dietary or herbal products. This would be no different for those who suffer from lupus. Since many women with lupus are taking specific medications for their disease, they should speak to their doctors about protecting themselves and the baby during pregnancy. Doctors will help design a lupus treatment plan that is safe.

It is important not to panic about medications and keep in mind that some people may be on medication that is considered safe during pregnancy, but again women will not know unless they have a discussion with a trusted physician first. Many people, who have autoimmune diseases, including lupus, are treated with hydroxychloroquine (Plaquenil) and prednisone. These medications have been deemed safe for pregnant women. Other medications, including methotrexate and cyclophosphamide (Cytoxan) shouldn’t be taken during pregnancy. Actually, it is advisable to stop taking these medications at least one month prior to getting pregnant.

10 Avoid Fatigue

Fatigue is common among those who have lupus. Many people who suffer from this autoimmune disease also have fibromyalgia and that too comes with fatigue. When you add pregnancy to the mix, it can be very challenging to muster up enough energy to get through a busy day. Getting plenty of rest is important for any pregnant woman and may be even more crucial for those who have lupus since fatigue is often already at play.

If a woman has lupus she needs to avoid any excess weight gain during a pregnancy and maintain a healthy, well-balanced diet, along with safe exercise. This can help keep the fatigue at a minimum. If a woman is pregnant, suffering from lupus, and finds that she is tired all the time, she should consider modifying her daily activities and routine.

Just so you get a sense of what lupus fatigue is like, consider this – some people with the disease have described just getting out of bed in the morning like climbing a mountain or they say cooking dinner is simply too difficult.

9 Prepare For Premature Baby

Since premature birth has been linked to lupus, it might be a good idea to learn about premature babies. Babies that are born early are at a higher risk for health problems, such as vision issues, learning disabilities, and breathing problems. The good news is that now-a-days even babies who weigh less than a pound have gone on to thrive and grow into healthy, active kids. It might help you to know that the survival rate for babies born as early at 26 weeks is about 80 percent.

To deal with the possibility of a premature birth, the best move you can make is to choose a hospital that specializes in neonatal intensive care. This will ensure that your baby gets special attention if he or she does happen to arrive earlier than expected. The most recent research suggests that close to 50 percent of pregnancies in women who suffer from lupus have premature deliveries. While there is a good chance of a pregnancy going full-term, it is certainly comforting to know that our healthcare system is equipped to handle these special bundles of joy.

8 Learn Signs Of Preeclampsia

One of the more common complications associated with pregnant women who have lupus is preeclampsia. This happens when there is a problem with the placenta, which of course helps nourish the baby. Experts believe that a change in the mother’s immune response to fetal/placental preeclampsia may also create problems.

If a woman is experiencing signs of preeclampsia she should get to the hospital. Some of the symptoms include, a sudden rise in blood pressure, severe headaches, blurred vision and an increase in the level of protein in urine after 20 weeks of pregnancy. People who have lupus and who are considering pregnancy should know preeclampsia used to be diagnosed if a pregnant woman had high blood pressure and protein in her urine. Now, health officials realize that it is possible to have preeclampsia, but not have protein in the urine.

When preeclampsia is suspected, the doctor will likely recommend close monitoring of the baby’s growth, usually through ultrasound.

Preeclampsia is a serious condition that requires medical attention and often immediate delivery of the baby.

7 Review Family History

People with lupus are already in the high-risk category when it comes to pregnancy so adding any other potential risk factors is just not a good idea. Before getting pregnant, a woman should be well aware of her family history in terms of pregnancies. Have their been other women in the family that have had difficult births? This family history along with any other risk factors such as excess weight, diabetes, or blood pressure can help doctors guide you as you move towards building a family. It wouldn’t hurt for a woman with lupus to query a family member about history prior to getting pregnant. It is also important to remember that certain personal factors will lead to lupus flares and possibly poor fetal outcome during pregnancy. Some of those factors include a history or current presence of kidney disease, history of low platelets, history of blood clots, history of presence of antiphospholipid antibodies and any previous history of preeclampsia.

6 Consider Food Choices

Now this may sound odd, but when considering pregnancy, diet is also one way to manage your health. While there is no specific lupus diet, studies have shown that certain foods can lead to flare-ups or worsen existing symptoms. Here’s an example – some research has revealed that people with lupus should avoid alfalfa sprouts. Alfalfa has been linked with lupus-like symptoms, including muscle pain, fatigue, kidney problems and abnormal blood test results. Some speculate it is due to a reaction to amino acid found in alfalfa sprouts and seeds. On the other side of the spectrum, foods with anti-inflammatory compounds, such as fresh fruits and vegetables can be helpful to those who have lupus. Also foods that contain omega-3 fatty acids, including fish, canola oil and ground flaxseed may also be helpful for those with inflammatory ailments like lupus.

Any foods that are high in antioxidants are good for people who have autoimmune problems. Avoiding saturated fat is best because they can cause more inflammation.

5 Consult With Other Sufferers

Sadly lupus has become common. This means people shouldn’t feel isolated and alone, especially if they do want to plan a family. There are many women who have had babies while dealing with lupus. There are support groups that allow for open discussion about the fears, anxieties and even anger associated with the disease. These support groups are usually facilitated by a professional and can give sufferers a sense of belonging and understanding. Women who have turned to lupus support groups often say that they have boosted both their physical and emotional wellbeing. Doctors agree that talking with someone who knows what living with lupus is like can give a person the strength to live life to the fullest and this means having children too.

Talking to a rheumatologist can often lead people to lupus support groups or other resources that can be helpful in managing the disease.

4  Exercise Regularly

When someone is suffering from lupus the idea of exercise can be frightening. This is due to the fact that many lupus sufferers are tired, have sore joints, and sore muscles. However, research shows that exercise is good for people who have lupus. It can help them deal with a lot of the aches, pains, and discomfort mentioned above. The American College of Rheumatology recommends that people with lupus, including those who are pregnant perform four types of exercises: flexibility, strengthening, aerobic, and body awareness. Body awareness exercises include yoga, Pilates and tai chi.

Lupus is a chronic illness and studies show that in addition to being good for the muscles, joints and bones, exercise when you have lupus benefits mental health. About 60 percent of people with chronic illness suffer from depression so an exercise routine is something to consider carefully.

3 Get Kidney Function Assessed

Since lupus causes inflammation of the small blood vessels that filter wastes in the kidneys sometimes the kidneys can get damaged. Having lupus kidney disease can increase the chances of pregnancy complications. When kidney function is a problem due to lupus, excess protein can leak into the urine and this leads to swelling in the feet, ankles and legs. Not all swelling during pregnancy is related to kidney malfunction though. Sometimes pressure from the growing fetus can lead to swelling.

If a woman with lupus has any reason to suspect that she may have a kidney function issue, she can have her kidneys assessed before she gets pregnant. In many cases where kidney issues exist, babies are delivered early. If the kidney problem is severe, there may be a point during the pregnancy where the doctor will suggest bed rest. This will allow for careful control of blood pressure and make it easier to monitor the fetus.

2 Monitor Temperature

Having a low-grade fever is not unusual when someone suffers from lupus. For some people with the disease an intermittent or continuous low-grade fever can be the norm. A low-grade fever is a temperature that does not exceed 102 F though. If a temperature rises higher than 102 F than it could be a sign of an infection. Lupus sufferers are more prone to skin, respiratory tract and urinary tract infections. They can also be prone to infection if they are taking immunosuppressive medications for their lupus.

Many infections are treated with antibiotics, but when a person is pregnant some of those antibiotics can be harmful to the fetus. A doctor will make a careful decision about medication should a pregnant lupus patient get an infection. If a woman has lupus and gets fevers on a regular basis, she will want to discuss this factor with her doctor before getting pregnant. As well, she may want to consider monitoring her temperature during pregnancy on a daily basis.

1 Don’t Ignore Unusual Signs/Symptoms

There are signs and symptoms that are what you would call typical indications that a person might be suffering from lupus. Fever, swelling of joints, muscle aches and pains, headaches and extreme fatigue are common, but anemia is another potential symptom. Anemia is when a person has a low number of red blood cells. Since each case of lupus is different, there could be signs and symptoms that are not considered classic.

When any unusual symptoms occur they should not be ignored. Follow-up with a doctor is important, particularly if you plan of getting pregnant or are expecting a baby. It could turn out that the symptoms are directly related to the pregnancy and not lupus or it could be a sign of some other underlying health problem. Obstetricians say that pregnant women with lupus shouldn’t go looking for trouble, but they also need to be aware of their bodies and any changes that happen during pregnancy that don’t seem to make sense or don’t feel right.

When a woman has lupus and wants to start and family or is already pregnant, it is only natural that she be a little nervous. No matter what state of health a person is in, of course having a healthy baby is the primary goal. While some of the steps to deal with lupus while pregnant may sound frightening, the reality is that many women are able to manage their disease with a little careful planning. There are hundreds of mothers with lupus that give birth to beautiful, healthy children every day.

Sources: WebMd.com, HopkinsLupus.org, WhatToExpect.com, Lupus.org, MayoClinic.org

 

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