Mostly, women of reproductive age suffer from lupus. Therefore, questions about lupus and pregnancy and about the influence of the disease on the baby are of great interest among women.
Types of Lupus
There are four main types of lupus:
Discoid lupus erythematosus – this type of lupus mainly affects the skin. It causes red, inflamed lesions that appear mainly on the face, ears and head. In 10% of patients, discoid lupus erythematosus turns into multi-organ systemic lupus erythematosus.
Drug-induced lupus erythematosus – may occur in people who take certain medications. These are usually drugs used to treat chronic diseases such as hypertension and heart disease. Once treatment is stopped, the symptoms usually disappear within a week or two.
Some symptoms of drug-induced lupus erythematosus coincide with those of systemic lupus erythematosus. These include muscle and joint pain, swelling, flu-like symptoms (fatigue and fever), serositis (inflammation around the lungs or the heart, causing pain or discomfort) and some abnormalities in the tests.
Systemic lupus erythematosus – is the most common and severe form of lupus. The disease has a negative effect on the liver, kidneys, skin, joints, lungs, heart, blood vessels and the nervous system. The course of the disease is unpredictable. Outbreaks of the disease alternate with remissions.
Newborn lupus erythematosus (neonatal lupus) is a rare condition. It is found in only 2% of children born by women who have certain antibodies – anti-Ro and anti-La. These antibodies can penetrate the placenta and cause inflammation of the developing baby’s skin or problems with the heart. A child is usually born healthy. At the same time, in the first few weeks of life the baby may develop a rash. What’s more, abnormal blood test results may appear. Lupus usually disappears when the child reaches the age of 3 – 6 months and does not repeat. Serious cases of neonatal lupus can cause a serious heart problem – the so-called congenital heart block.
What exactly leads to the appearance of lupus is still not known. But modern doctors agree that the cause of lupus during pregnancy can be a combination of hormones and environmental elements, especially if a person has a genetic predisposition to the disease.
There are also some factors that increase the risk of developing lupus:
- Race. Lupus is most common in African Americans, Hispanics and Asians;
- Gender. The disease affects women more than men;
- The age. Lupus develops in people of all ages, including newborns. But most often it affects people between the ages of 15 and 44;
- Sunlight. In people who are susceptible to lupus, exposure to sunlight can cause skin damage or an exacerbation of the disease;
- Impact of the chemicals. Some studies have shown that exposure to certain chemicals may increase the risk of lupus;
- Smoking. Smoking cigarettes may increase the risk of developing lupus.
A few years ago, the prospects for lupus and pregnancy were quite gloomy and disappointing. But nowadays, provided that the woman receives proper medical care, all the risks associated with lupus and pregnancy can be significantly reduced. Today, many women with lupus are capable of giving birth to a healthy child. Careful planning of pregnancy significantly increases your chances of a normal pregnancy.
Most doctors recommend that women with lupus postpone attempts to become pregnant until the remission of the disease. It should last for at least six months. This is especially important for women who suffer from kidney disease.
The polymorphism of symptoms is characteristic. The main ones are the following:
- Lesion of the skin (rashes on the skin, more often on the face in the form of a butterfly, alopecia);
- The damage of joints (arthralgia, arthritis). Lesions of serous membranes (pleuritis, pericarditis, peritonitis). Heart damage can also occur as a polypous endocarditis on the mitral and tricuspid valves;
- Pressure of the lungs (vascular pneumonia due to pulmonary vasculitis, chronic interstitial processes);
- Lesion of the gastrointestinal tract (dyspeptic phenomenon, lack of appetite, diarrhea, vascular hemorrhagic phenomena in the intestine, spleen, pancreas);
- Renal failure (lupus glomerulonephritis);
- Psychic-mental disorders with lesion of central and peripheral nervous system.
Features of the Course of Lupus and Pregnancy
During pregnancy, there is a shift in the hormonal balance in the body of a woman. This often provokes the formation of lupus erythematosus. Conversely, in a woman with a lupus diagnosis, the disease can go to the stage of remission. But, as a rule, some time after delivery, the condition returns to the former state. Or the disease can rapidly progress in the form of residual postpartum phenomena: nephropathy, sepsis.
Pregnancy worsens the course of the disease. This is a real threat to the life of the mother and the fetus.
For systemic lupus erythematosus, haematological disorders are characteristic. They can be the cause of bleeding in the consecutive and early postpartum periods. The disease is usually not passed from the mother to the children. But in the blood they have a placental lupus factor. It appears in the fetus from about 3-4 months of intrauterine development and disappears after reaching the 6-month-old age of the child. Almost half of the children have heart diseases after birth.
Management of Lupus and Pregnancy
Management of lupus and pregnancy is done individually. The issue of preservation or interruption of pregnancy is decided by a gynecologist in conjunction with a therapist and rheumatologist. Particular attention is paid to the manifestation of the symptoms of the disease in each case individually. The results of the examination and the general condition of the pregnant woman are also taken into account. Both the woman and the doctor should be prepared for any outcome of the events.
If the disease is in the acute stage, when the kidneys and the heart are affected, pregnancy is contraindicated unequivocally.
Unfortunately, one cannot predict the behavior of lupus and pregnancy. In one third of women the disease is aggravated. Another one third may not have any changes during the course of the disease. In other women, pregnancy can lead to alleviation of the symptoms of lupus. And almost every seventh pregnant woman with a diagnosis of lupus develops severe complications that threaten the life of the mother and the fetus.
Lupus and Pregnancy: Possible Complications
Women suffering from lupus during pregnancy are at risk for developing certain complications. If you become pregnant at a time when lupus is in an active stage, or if you have had serious illness outbreaks during pregnancy, you are much more likely to have the following complications:
About 13% of women sick with lupus suffer from high blood pressure. Also, they have protein in their urine. These symptoms indicate a serious condition known as preeclampsia. Such a situation requires immediate treatment, which may even be premature delivery. Preeclampsia affects 3% – 8% of pregnant women. Women suffering from kidney failure related to lupus erythematosus are at high risk for pre-eclampsia.
About 25% of children whose mothers suffered from lupus are premature. The cause of premature birth is not only the disease itself, but also medicines that are widely used to treat lupus.
Impairment of fetal growth
Children of mothers with lupus are at higher risk of intrauterine growth retardation. This means that the child may be much smaller than expected. A doctor can diagnose a delay in fetal growth with the help of ultrasound. Retardation of intrauterine growth occurs in about 15% of lupus and pregnancy combination. This probability can be further increased if a pregnant woman suffers from pre-eclampsia, or if she receives treatment with steroid or immunosuppressive medications during pregnancy.
Formation of blood clots in the placenta
In some women the combination of lupus and pregnancy leads to the formation of antibodies. They, in turn, form blood clots (thrombi) in the placenta. These clots interfere with normal growth and functioning of the placenta. As a child receives vital nutrients through the placenta, the presence of blood clots in it can slow the child’s growth.
Lupus and Pregnancy: Treatment
Nowadays it is proven that only 25% of lupus and pregnancy results in miscarriage and stillbirth. The risk of premature birth is also around 25 %. At the same time, the possibility of a normal pregnancy and birth of a healthy baby reaches 50 %.
Of course lupus can complicate the course of pregnancy. But in most cases, these complications can be eliminated.
Keep in mind that some drugs have an adverse effect on the fetal development. So, the treatment of lupus during pregnancy has its own characteristics. Some drugs are indicated only for life-threatening conditions. It is very important that the pregnant woman receive adequate, necessary treatment with minimal risk for the child. Do not stop the course of therapy, as this can lead to a relapse of the disease. Particular attention should be paid to the pre-natal condition of the fetus.
A pregnant woman should be under strict, constant supervision of a gynecologist, rheumatologist and therapist. Since the risk of premature birth is high, it is better if the woman is under supervision in a specialized clinic where there are conditions for nursing preterm infants.