Systemic lupus erythematosus (SLE)
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- The single most helpful thing is to plan: conceive when lupus is quiet, on medicines that suit pregnancy.
- Keep taking hydroxychloroquine unless your team tells you otherwise.
- Reliable contraception matters until you are ready to conceive, especially on medicines that are unsafe in pregnancy; IUDs and implants are the most effective, and estrogen-containing methods are avoided if you have antiphospholipid antibodies.
What to know
Will pregnancy affect my lupus?
Flares can complicate up to half of lupus pregnancies, mostly when lupus is active at conception. When lupus is well controlled, flares are uncommon: in one study of over 300 people with mild-to-moderate disease at conception, fewer than 10 in 100 had mild flares and only 3 in 100 had severe flares.
Will lupus affect the pregnancy?
Lupus can raise the chance of high blood pressure in pregnancy (pre-eclampsia), early birth, and, less often, pregnancy loss. Good control before and during pregnancy lowers these risks.
Fertility
Lupus itself usually does not reduce your ability to get pregnant.
Contraception
Because some lupus medicines are unsafe in pregnancy, and an unplanned pregnancy can set off a lupus flare, reliable contraception matters until you are ready to try for a baby. It is worth talking about early, before it becomes urgent. The most reliable options are the intrauterine device (an IUD, either copper or hormonal) and the contraceptive implant, and both are safe to use with lupus and with immune-calming medicines. If you have antiphospholipid antibodies, a clotting tendency that can go along with lupus, methods that contain estrogen (the combined pill, the patch, and the ring) are best avoided because they add to the risk of clots; an IUD or a progestin-only method is used instead. If you take mycophenolate, which is especially unsafe in pregnancy, an IUD or two other methods used together are advised. Your team can help you find what suits you, and barrier methods such as condoms also protect against sexually transmitted infections.
Planning ahead
Aim to conceive when lupus has been quiet for about 6 months, on medicines that suit pregnancy. Your team may test for certain antibodies and switch some medicines ahead of time.
Medicines
Hydroxychloroquine is usually continued. Low-dose aspirin is often added to lower the chance of pre-eclampsia. Some medicines are stopped before pregnancy and swapped for pregnancy-compatible options.
Monitoring in pregnancy
You will have closer checks of blood pressure, urine, and blood tests, plus extra ultrasounds. If you carry certain antibodies, your baby's heart will be monitored.
Flare or pregnancy complication?
Some lupus flare symptoms can look like pregnancy complications such as pre-eclampsia. Your team uses specific tests to tell them apart, which is one reason the extra monitoring matters.
After birth
Flares can happen after birth, so your team keeps a close eye on you. Most lupus medicines that suit pregnancy also suit breastfeeding.
The numbers, in plain terms
fewer than 10 in 100
Among people with mild-to-moderate lupus at conception, fewer than 10 in 100 had mild flares in pregnancy, and only 3 in 100 had severe flares.
2 in 100
In a prospective study of 100 anti-Ro/SSA-positive women with a connective tissue disease, 2 in 100 babies were born with complete congenital heart block.
When to call your team
- Severe or persistent headache, vision changes, or swelling of the face and hands (possible pre-eclampsia).
- Reduced or absent baby movements.
- New or worsening lupus symptoms: joint swelling, rashes, chest pain, or foamy urine.
- Any bleeding, or contractions before your due date.