Lupus is an autoimmune disease with an unclear cause, resulting in damage to all organs in the patient’s body. More than 90% of lupus cases occur in women of childbearing age. Therefore, pregnancy in this group requires careful consideration.
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| To avoid serious complications, female lupus patients should consider pregnancy during the remission phase (Image: att) |
In the past, medical advice often suggested that individuals with lupus should not become pregnant or should terminate the pregnancy if already pregnant. However, due to significant advancements in understanding the disease mechanisms and the introduction of various new immunosuppressive medications, treatment effectiveness has improved dramatically.
Statistics show that, under careful monitoring by specialized doctors, approximately 25% of pregnancies in lupus patients result in preterm births, and 25% lead to miscarriages. The remaining patients have normal pregnancies and deliveries.
To minimize severe complications, female lupus patients should aim to conceive during periods of disease remission when their health is stable, as this reduces the risk of disease flare-ups. If conception occurs during active disease or when kidney damage is present, the risk of exacerbation is significantly higher. In reality, the number of pregnancies among female lupus patients is lower than that of women without the disease, primarily due to the prolonged use of high-dose corticosteroids and certain immunosuppressants, notably cyclophosphamide, which can impair fertility.
Additionally, lupus can disrupt the menstrual cycle, further diminishing fertility. During pregnancy, there may be increased flare-ups of the disease, such as joint pain due to ligament stretching and rashes due to vasodilation. Most flare-ups occur within the first six months of pregnancy or in the two months postpartum, with mild symptoms such as fever, joint pain, and rashes that are typically manageable.
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Lupus Disease (Image: emedicinehealth) |
Statistics indicate that about 3% of lupus patients give birth to children with neonatal lupus syndrome. This syndrome includes abnormal rashes, blood cell count issues, and heart rhythm disturbances. If there are no heart rhythm problems, the condition typically resolves on its own within 3-6 months without lasting effects.
One of the significant factors affecting the fetus in lupus patients is the presence of anti-phospholipid antibodies. These antibodies are found in 1/3 of cases. They can cause blood clots that obstruct blood flow to the placenta, leading to inadequate placental development and hindering its normal function. Since the placenta is responsible for transporting nutrients from the mother to the fetus, inadequate placental development can result in a weak and underdeveloped fetus. The greatest risk for mothers with lupus during pregnancy is preterm delivery. Premature infants often experience breathing difficulties, jaundice, and anemia. However, in some modern neonatal intensive care facilities, these conditions can be addressed. In cases of extreme prematurity or if the mother suffers from thrombocytopenia or is in poor health, cesarean delivery may be performed. This method is considered safe for the patient.
For pregnancies over 30 weeks with a weight of 1.5 kg, survival and normal development are possible. These infants can breastfeed, but mothers need to be cautious when using medications such as hydroxychloroquine, azathioprine, and cyclophosphamide because these drugs can be secreted in breast milk and absorbed into the infant’s bloodstream, potentially causing toxicity. Other medications, like prednisone, may lead to decreased milk production. Some premature infants may not be able to suckle adequately, in which case the mother should express milk to feed the baby. Ideally, lupus patients on medication to manage their condition should avoid breastfeeding.
To limit unwanted complications during and after pregnancy, mothers must continue to use necessary medications to control their disease. Medications that do not cross the placenta and are safe for the fetus that mothers can use to manage lupus during pregnancy include prednisone, prednisolone, and methylprednisolone. Drugs that are toxic to the fetus, such as cyclophosphamide, should be avoided to ensure that children are not at risk for developmental delays or congenital abnormalities. Dexamethasone and betamethasone should also be avoided, as these medications can cross the placenta and cause fetal abnormalities.
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