Pregnancy and Systemic Lupus Erythematosus

In some studies 6 - 15% of women report fewer flares during pregnancy. Most flares occur during the first or second trimester and 2 months after delivery. Women who conceive after at least 6 months of remission have a lower risk for flares.

Effect of SLE During and After Pregnancy

All lupus pregnancies are regarded as high risk. Evidence has suggested that 75% of pregnancies are carried to term, although 25% of the babies may be premature. (Newer treatments help improve these rates.) A mother’s lupus can harm the fetus even before her symptoms appear. A 2005 study reported that the risk of still births was 10 times greater for women who had not yet been diagnosed with lupus, and four times greater for women with diagnosed lupus, compared with healthy women. This study suggests that lupus may have a predisease state. Women with lupus and predisease lupus also had more preterm births and low weight babies.

Miscarriage. About 25% of SLE pregnancies result in miscarriage. The risk for miscarriage is highest in patients with one or more of the following conditions:

• Women who have antiphospholipid antibodies that cause blood clotting problems
• Women who have active kidney disease
• Women with high blood pressure

Bleeding in Pregnant Woman. There is an increased risk for bleeding problems after the birth, due to either anti-SLE drugs or SLE itself.

Preeclampsia. Preeclampsia, a dangerous condition associated with high blood pressure that occurs during pregnancy, develops in 20% of pregnant SLE women.

Pulmonary Hypertension. In this condition, blood pressure in the lungs increases, which can be life-threatening. It is not common in SLE pregnancies but some cases have been reported.

Managing SLE During Pregnancy

Many drugs used to treat SLE are safe to take during pregnancy. Caution is advised with antimalarial and immunosuppressant drugs, and cyclophosphamide should always be avoided.

Women with antiphospholipid syndrome (APS) are usually treated with prednisone and aspirin Investigators have studied a combination of aspirin and standard heparin (a blood-thinning drug). A 2002 study suggested, however, that low-dose aspirin worked just as well as the combination or heparin alone. Experts reviewing the study recommended avoiding heparin if possible. A newer form of heparin called low-molecular-weight heparin (LMWH), which includes enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep), is proving to be beneficial and safer than standard heparin. Investigators are also testing intravenous immunoglobulin, which is showing excellent results. The optimal treatment is still in question, although a 2003 study suggested that LMWH plus aspirin, which achieved an 84% life-birth rate, may be the best option at this time for many women.

One study indicated that any pregnant women with SLE should be treated with heparin. In the study, when all pregnant SLE women were treated with heparin, the infant survival rate was 93% compared to only 77% when heparin was given only to women with APS.

Dangers to the Newborn

Thrombocytopenia. During pregnancy anti-phospholipid antibodies may also cross the placenta and cause thrombocytopenia (drop in platelets) in the fetus, although babies with low-platelet counts are nearly always delivered safely.

Neonatal Lupus. Another known risk to the baby is neonatal lupus, which occurs in 3% of SLE pregnancies and usually resolves within 6 months.