The Relationship Between Women Affected With Lupus and Pregnancy
Author: Groshan Fabiola
It is known that lupus affects a lot of young women, and for a long time, it was thought that if these women remain pregnant, they must have therapeutic abortions. Nowadays, it is known that the conclusion was wrong. Studies showed that 50% of all lupus pregnancies are completely normal, 25% deliver normal babies prematurely, and there is a percentage of 25 which represents fetal loss due to spontaneous abortion or death of the baby.
However, lupus pregnancies are not easy, and they may be considered ‘high-risk’. Pregnant lupus patients should be supervised by obstetricians who are familiar with high risk pregnancies and there should be a collaboration with woman’s primary physician.It is important that the delivery to be planned to a hospital that has a unit specialized in the care of premature newborns.
Despite the older texts that said lupus flares are common in pregnancy, studies discovered that is not true, and eventually can happen very rare.In stead, about 6-15 % of lupus patients will experience an improvement in lupus symptoms during pregnancy. It is known that flares can appear during the first or second trimester, or during the two months immediately after delivery.Arthritis, rashes and fatigue are symptoms that these flares show. It was shown that 33% of the lupus patients will have a decrease in platelet count during pregnancy, and about 20% will have an increase in or new occurrence of protein in the urine.It is known that lupus nephritis before conception increases the chance of experiencing a lupus flare during pregnancy.
During pregnancy fluid may accumulate in the joints, especially in the knees, and that will cause swelling. This may suggest an increase in inflammation due to lupus, but it also can be a normal thing during pregnancy. Many patients can experience new hair growth during pregnancy, and after delivery dramatic hair loss appears. This can be a symptom of lupus, but it can also happen to occur during a normal pregnancy.An important thing that must be done is to distinguish the symptoms of a lupus flare from the normal body changes that occur during pregnancy.
A lot of women wonder when is the best time to get pregnant. It is important that a woman who wants to become pregnant to be in good health, in this way her baby will have less problems, and there will be less concerns. It is important to follow some rules, for example to stop drinking or smoking, to eat well, to take medications as prescribed and to visit your doctor regularly.
Frequent visits to the doctor are important, because in high risk pregnancies can appear a lot of situations, and treating them is easier if they are found early.In 20% of lupus patients can appear the toxemia of pregnancy. This consists in a sudden increase in blood pressure, protein in the urine, or both during pregnancy.It appears more often in women with kidney disease, in black women, in women with twins, in older women, in women with high blood pressure, and in women who smoke.Toxemia is a serious condition, and must be treated at once. In this case there should be no danger for the woman, but there is a high risk that the baby will die if it is not rapidly delivered. If toxemia is not treated, the woman and the baby are in danger.It is also important as pregnancy progresses that the doctor to check the baby’s growth with sonograms, and the heart beat, because if there are found abnormalities, means that there is a problem that must be treated.
During pregnancy, it is important to take only the necessary medications. It is known that most of the medications taken by lupus patients are safe to use during pregnancy.Some medications do not get through the placenta and are safe for the baby, and we can mention here prednisone, prednisolone and probably methylprednisolone.Other medications like dexamethasone and betamethasone reach the baby and they are used only if it is necessary to treat the baby too.It is also known that aspirin is safe, azathioprine and hydroxychloroquine seem to be harmless for the babies, but this is not quite sure, but Cyclophosphamide is surely harmful if taken in the first three months of pregnancy.
There are opinions that pregnant women with lupus should take small doses of prednisone to prevent early abortion, and steroids should be given after the baby is born to prevent post partum flare, but there aren’t proofs that these are necessary.
It was shown that 33% of lupus patients have antibodies that interfere with the function of the placenta. This antibodies are known as the antiphospholipid antibodies, the lupus anticoagulant, or anti-cardiolipin antibodies. These antibodies may cause blood clots in the placenta, and that does not allow the placenta to grow and function normally. In this way, the baby grows slowly, because the placenta is the passage way for nourishment from the mother to the baby. Prednisone, heparin, aspirin and plasmapheresis have been suggested as possible therapies, but the treatment is still being tested.
Studies revealed that about 50% of lupus pregnancies end premature, because of the complications that can appear. Premature babies may become anemic, may have difficulty breathing and may develop jaundice. In modern neonatal units, these problems can be easily treated, and even babies which had very little weight survived.
Anti-Ro or anti-SSA is an antibody that can be found in about 33% of lupus patients. It was discovered that about 10% of women with anti-Ro antibodies will have a baby with a syndrome known as neonatal lupus. A transient rash, transient blood count abnormalities, and a special type of heart beat abnormality is specific to neonatal lupus. The heart beat abnormality is rare, and treatable, and for babies with neonatal lupus who do not have the heart problem, there is no trace of the disease by 3-6 months of age, and it does not recur. It is known that neonatal lupus is the only type of congenital abnormality found in children of mothers with lupus. There is a 25% probability that if a mother had a child with neonatal lupus, she will have another one with the same problem.
There are situation when Caesarian section is needed. This must be done when the baby shows signs of stress, it is very premature, the mother of the baby has low platelets, or is very ill. This may be the safest and fastest method in these cases, and it is good to know that the decision about type of delivery is not made in advance, because it will be determined by the specific circumstances at the time of delivery.
It is known that breast feeding is possible for lupus patients, but if the baby is born very prematurely, he is not strong enough to suckle, and so, cannot draw the milk. But, if the mother wishes so, the milk can be pumped from the breast to feed the premature baby. If you take medications, it is important to ask your doctor if you are allowed to breast feed.
It is important to remember that as a lupus patient, you will have future periods of illness, and it is important to have plans in advance for alternate child care if it is necessary.
For more resources about systemic lupus please review this http://www.lupus-guide.com/symptoms-of-lupus.htm or even http://www.lupus-guide.com/lupus-treatment.htm