Lupus and Pregnancy
Topic Overview
Lupus (systemic lupus erythematosus, or
SLE) doesn't generally affect a woman's ability to conceive. However, if you
are having a lupus flare or are taking
corticosteroid medicines, you may have irregular
menstrual cycles, making it difficult to plan a pregnancy.
If you
plan to have a baby or are already pregnant, it is very important that you and
your primary doctor discuss how lupus may affect your pregnancy.
- Most women with lupus have successful
pregnancies. Women who become pregnant during lupus
remission are more likely to have a successful
pregnancy.
- Lupus increases the risk of fetal and pregnancy
complications, including premature birth and stillbirth. This risk is greatest
among women who have kidney problems or antiphospholipid, anti-Ro, or anti-La
antibodies.1
- Some women with lupus need to
take medicines or have regular
fetal monitoring or
ultrasound while they are pregnant to reduce the risk
of complications.
- It is not clear whether women with lupus are more likely to have flares during pregnancy.2
If you have miscarried before, expect that your pregnancy
will be closely monitored. Talk to your doctor about whether you have tested
positive for antiphospholipid antibodies. If so,
anticoagulant treatment may improve your chances of
having a healthy pregnancy.
Can I still take my lupus medicines?
You may not
be able to stop taking lupus medicines after becoming pregnant, or you may
need to start taking medicine for a symptom flare. Some lupus medicines,
like acetaminophen and prednisone, are considered safe during pregnancy. Others
may not be.
- Immunosuppressant medications, which may be
prescribed for severe lupus, can cause birth defects. Do not take
immunosuppressants if you are pregnant or wish to become
pregnant.
- Corticosteroids (such as prednisone) are generally
considered safe for use during pregnancy. But these drugs are still used at the lowest doses and for the shortest time possible.3
- Cytotoxic medications
such as methotrexate and cyclophosphamide are stopped during pregnancy. They should be discontinued
several months before conception.
- One study suggests that
hydroxychloroquine (such as Plaquenil) is safe for use during
pregnancy.4
- Nonsteroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen and aspirin should be
avoided during pregnancy unless prescribed by a doctor.
References
Citations
- Lockshin MD (2008). Systemic lupus erythematosus. In
DC Dale, DD Federman, eds., ACP Medicine, section 15,
chap. 4. New York: WebMD.
- Crow MK (2008). Systemic lupus erythematosus. In L
Goldman, D Ausiello, eds., Cecil Textbook of Medicine,
23rd ed., pp. 2022–2032. Philadelphia: Saunders Elsevier.
- Hahn BH (2008). Systemic lupus erythematosus. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 2075–2083. New York: McGraw-Hill Medical.
- Costedoat-Chalumeau N, et al. (2003). Safety of
hydroxychloroquine in pregnant patients with connective tissue diseases.
Arthritis and Rheumatism, 48(11): 3207–3211.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer |
Stanford M. Shoor, MD - Rheumatology |
| Last Revised |
May 7, 2010 |
Last Revised:
May 7, 2010
Lockshin MD (2008). Systemic lupus erythematosus. In
DC Dale, DD Federman, eds., ACP Medicine, section 15,
chap. 4. New York: WebMD.
Crow MK (2008). Systemic lupus erythematosus. In L
Goldman, D Ausiello, eds., Cecil Textbook of Medicine,
23rd ed., pp. 2022–2032. Philadelphia: Saunders Elsevier.
Hahn BH (2008). Systemic lupus erythematosus. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 2075–2083. New York: McGraw-Hill Medical.
Costedoat-Chalumeau N, et al. (2003). Safety of
hydroxychloroquine in pregnant patients with connective tissue diseases.
Arthritis and Rheumatism, 48(11): 3207–3211.
