Lupus and Pregnancy

pregnant black woman

Twenty
years ago, medical textbooks said that women with lupus should not get pregnant
because of the risks to both the mother and unborn child. Today, most women with
lupus can safely become pregnant. With proper medical care, you can decrease the
risks associated with pregnancy and deliver a normal, healthy
baby.

To
increase the chances of a happy outcome, however, you must carefully plan your
pregnancy. Your disease should be under control or in remission before
conception takes place. Getting pregnant when your disease is active could
result in a miscarriage, a stillbirth, or serious complications for you. It is
extremely important that your pregnancy be monitored by an obstetrician who is
experienced in managing high-risk pregnancies and who can work closely with your
primary doctor. Delivery should be planned at a hospital that can manage a
high-risk patient and provide the specialized care you and your baby will need.
Be aware that a vaginal birth may not be possible. Very premature babies, babies
showing signs of stress, and babies of mothers who are very ill will probably be
delivered by cesarean section.

One
problem that can affect a pregnant woman is the development of a lupus flare. In
general, flares are not caused by pregnancy. Flares that do develop often occur
during the first or second trimester or during the first few months following
delivery. Most flares are mild and easily treated with small doses of
corticosteroids.

Another
complication is pregnancy induced hypertension. If you develop this serious
condition, you will experience a sudden increase in blood pressure, protein in
the urine, or both. Pregnancy-induced hypertension is a serious condition that
requires immediate treatment, usually including delivery of the
infant.

The most
important question asked by pregnant women with lupus is, “Will my baby be
okay?” In most cases, the answer is yes. Babies born to women with lupus have no
greater chance of birth defects or mental retardation than do babies born to
women without lupus. As your pregnancy progresses, the doctor will regularly
check the baby’s heartbeat and growth with sonograms. About 10 percent of lupus
pregnancies end in unexpected miscarriages or stillbirths. Another 30 percent
may result in premature birth of the infant. Although prematurity presents a
danger to the baby, most problems can be successfully treated in a hospital that
specializes in caring for premature newborns.

About 3
percent of babies born to mothers with lupus will have neonatal lupus. This
lupus consists of a temporary rash and abnormal blood counts. Neonatal lupus
usually disappears by the time the infant is 3 to 6 months old and does not
recur. About one-half of babies with neonatal lupus are born with a heart
condition called heart block. This condition is permanent, but it can be treated
with a pacemaker.

            Planning your
Pregnancy

You and
your spouse or partner should talk to your doctor about the possibility of
pregnancy. You and the doctor should be satisfied that your lupus condition is
under good control or in remission. Your doctor should also review potential
problems or complications that could arise during the pregnancy, their
treatment, and outcomes for both you and the unborn child.

You
should select an obstetrician who has experience in managing high-risk
pregnancies. Additional experience in managing women with lupus is also good.
The obstetrician should be associated with a hospital that specializes in
highrisk deliveries and has the facilities to care for newborns with special
needs. It is a good idea to meet with the obstetrician before you become
pregnant so that he or she has an opportunity to evaluate your overall condition
before conception. This meeting also will give you the opportunity to decide if
this obstetrician is right for you.

Check
your health insurance plan. Make sure that it covers your health care needs and
those of the baby and any problems that may arise.

Review
your work and activities schedule. Be prepared to make changes if you are not
feeling well or need more rest.

Consider
your financial status. If you work outside the home, your pregnancy and
motherhood could affect your ability to work.

Develop a
plan for help at home during the pregnancy and after the baby is born.
Motherhood can be overwhelming and tiring, and even more so for a woman with
lupus. Although most women with lupus do well, some may become ill and find it
difficult to care for their child.

            After the Baby is Born
(The Postpartum Period)

Be sure
your doctor or nurse reviews with you the physical and emotional changes that
occur as your body returns to normal. These changes are the same as those
experienced by women who do not have lupus.

Be aware
that postpartum complications can arise. In addition to those that any woman who
has been pregnant can experience, you might develop a lupus
flare.

Try to
breastfeed your baby. It is the ideal, low-cost way to provide nutrition for
your baby in the first weeks or months of life. It takes time for mothers and
babies to learn how to breastfeed and it may take a few weeks to get adjusted.
Because breastfeeding can sometimes be a challenge, ask your doctor or nurse for
help so you do not become discouraged. Sometimes, though, breastfeeding may not
be possible for the following reasons:

·
A premature baby may
not be able to suck adequately. Feeding your baby through a tube at first and
then by bottle may be necessary. However, you may still be able to pump your
breast milk for your baby.

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Lupus Biomarkers Discovered

 

know lupus picturePeople with lupus have certain molecular biomarkers that aren’t present in
those without the disease, a small, preliminary study has
found.

“There are currently
no defined biomarkers for lupus,” said lead researcher Dr. Nilamadhab Mishra, an
assistant professor of rheumatology at the Wake Forest University School of
Medicine, in Winston-Salem, N.C.

But, in their new
study, Mishra and his colleagues found that people with lupus have changes in
their micro-ribonucleic acids (microRNAs) that aren’t found in people who don’t
have lupus. “We found 40 are differently expressed between lupus patients and
controls,” he said.

“RNA acts like a
mold for proteins,” to help determine what the form and function of genes’
proteins will be, explained Dr. Joan Merrill, medical director of the Lupus
Foundation of America.

Mishra presented the
findings on Friday at the American College of Rheumatology meeting, in
Washington, D.C.

Lupus is a chronic
autoimmune disease that can damage the joints, kidneys, heart, lungs, brain,
blood and skin, according to the Lupus Foundation of America (LFA). The LFA
estimates that about 1.5 million Americans have the disease. It occurs 10 to 15
times more often in women than in men.

The disease can vary
greatly in severity from person to person, and even for an individual. Some
people with lupus have periods of time when no symptoms are present. Common
symptoms include achy joints, frequent fevers, extreme and lasting fatigue, a
skin rash and anemia.

There are no
definitive diagnostic tests for lupus, and because symptoms can come and go, it
often takes months, and possibly years, before a person can be diagnosed,
according to LFA.

For the new study,
the researchers compared the microRNA from five people with lupus to seven age-
and sex-matched people without lupus. The people with lupus were not
experiencing symptoms of the disease at the time of the study and were not
taking commonly prescribed lupus medications during the study
period.

The researchers
found 40 microRNAs with a 1.5-fold difference in expression between the people
with lupus and the control participants. Six microRNAs had a greater than 3-fold
difference in expression.

“We hope we’ve found
a biomarker that can be helpful for diagnosis and to help guide treatment,” said
Mishra, who added that it might also be possible to develop a new targeted
treatment based on this and other research.

Said Merrill: “It
looks like lupus patients are making funny RNA even when the disease isn’t
flaring.”

Merrill cautioned
that while this “novel research is very good research,” it’s a preliminary study
done on a small group of people, and more work needs to be
done.

Mishra said one of
the next steps is to see if these microRNA changes are present in other
autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis, or if they
are exclusive to lupus. He also agreed that the current work needed to be
replicated in a larger trial.

“What’s important is that there’s a lot of research going on right now
about the many tiny reactions that occur in lupus. Over the next few decades, we
may develop medications that are strategic,” said Merrill. “We’re working on
trying to fix a few small interactions between proteins, rather than wallop the
whole immune system.”