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Lupus and Pregnancy

Topic Overview

Lupus (systemic lupus erythematosus, or SLE) doesn't typically affect a woman's ability to conceive. But 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 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.
  • Women are encouraged to wait until lupus is under control for at least 6 months before they try to become pregnant.
  • 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.

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.

Men with lupus should talk with their doctors. Some medicines should be stopped for at least 3 months before a man tries to conceive a baby.

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 medicines, 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.
  • Cytotoxic medicines such as methotrexate and cyclophosphamide are stopped during pregnancy. They should be discontinued several months before conception.
  • A review of studies of antimalarials such as hydroxychloroquine (Plaquenil) suggests that they are safe for use during pregnancy.1
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin should be avoided during pregnancy unless prescribed by a doctor.

References

Citations

  1. Ruiz-Irastorza G, et al. (2010). Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: A systematic review. Annals of the Rheumatic Diseases, 69(1): 20–28.

Credits

By Healthwise Staff
Anne C. Poinier, MD - Internal Medicine
Anne C. Poinier, MD - Internal Medicine
Stanford M. Shoor, MD - Rheumatology
Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
Last Revised May 7, 2012

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