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Pregnancy and Family Planning

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Many women with lupus do well during pregnancy, giving birth to full-term babies with no complications. While disease flares may be more frequent during pregnancy, they usually are mild. However, before a woman with lupus becomes pregnant, she should contact her doctor. Doing this can increase the chances of a healthy outcome for mother and child. Many women with lupus see a special "high-risk obstetrician" specializing in complicated pregnancies.

Do women with lupus have fertility problems?
Women with lupus are just as likely to get pregnant as other women their age. Advance planning is important, however, since certain lupus medicines are not good for a growing fetus to be exposed to. Many experts recommend trying to get pregnant after the lupus has been quiet (no flares) for at least six months.

Once a woman with lupus is pregnant, what is the likelihood of a problem?
A woman with lupus is more likely than women without the disease to have a miscarriage or develop high blood pressure (called pre-eclampsia) that can end a pregnancy. Also, in up to half of all lupus pregnancies, the baby is born before it is fully developed. This is called premature delivery. The baby usually can be treated for any problems caused by premature delivery, and most do well in the end.

Why is the risk of miscarriage higher in women with lupus?
About one-quarter to one-third of women with lupus have substances in their blood called antiphospholipid antibodies (aPL). These antibodies make it more likely that a miscarriage, or a blood clot (even when not pregnant) will occur. For these reasons, a woman with lupus should always be tested for these antibodies right away if she becomes pregnant, and may be started right away on a strong blood thinner called heparin. Taken throughout the pregnancy, this medicine and a baby aspirin (81 mg) make the blood less sticky and lower the risk of miscarriage.

Are babies of mothers with lupus healthy?
Usually, yes. They have no greater chance of a birth defect or mental retardation than do children born to women without lupus. However, a small number of babies—about 2 in every 100—born to women with specific antibodies in the blood (called anti-Ro or anti- SSA) have a condition called neonatal lupus. This involves either a blockage in the heart that makes it beat more slowly than it should, or a rash that usually disappears about six months later. All pregnant women with lupus should have a screening test for these antibodies.

A special picture of the growing baby's heart (a fetal echocardiogram) at about 14 weeks of pregnancy can show if the heart problem has developed. In about one in five babies with neonatal lupus, the heart problem causes death. Most do just fine, though, with a permanent pacemaker that keeps the heart beating regularly through infancy and into adulthood.

What is the best kind of birth control for a woman with lupus to use?
For a woman with lupus, the very personal choice of which birth control method to use is complicated by the fact that one of the main options—birth control pills (oral contraception)—usually contain female hormones that many experts long believed could trigger or worsen lupus. The experts are thinking differently about this now, so a woman with lupus should talk things over with her doctor. Birth control options that present the usual risks and benefits for people with lupus include barrier methods of contraception (condom, diaphragm, IUD).

Reviewer: H. Michael Belmont, M.D.
Spring 2006

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