Achieving motherhood with lupus

Many women with lupus have concerns about becoming pregnant and carrying a healthy child to term. This is because the condition is usually diagnosed in women of childbearing age.

So what is lupus?

It’s an autoimmune disease where the body’s immune system mistakenly attacks healthy tissue in many parts of the body. The 12th-century Italian physician, Rogerius Frugard, first recorded Lupus in the Middle Ages. He coined the term ‘lupus’ after the mask that some women wore to conceal the rash associated with the condition.

Signs and symptoms of lupus include:

  • Joint and muscle pain
  • Extreme fatigue
  • Persistent low-grade fevers
  • Butterfly rash across the bridge of the nose and cheeks
  • Weight loss
  • Hair loss
  • Photosensitivity (sun or light sensitivity)
  • Pleurisy (pain in the chest on deep breathing)
  • Persistent headaches

Unfortunately, there is no cure for the condition. Although the management improves with every decade, as does our understanding of lupus.

Who has lupus?

Lupus has a high prevalence in the Afro Caribbean community and affects around one in every 185 Americans. 90% of those diagnosed with lupus are female, and diagnosis is most often made during childbearing years.

Lupus and fertility

Lupus does not affect fertility, so a lupus patient is likely to be as fertile as a non-lupus patient. However, some of the drugs used to treat lupus, such as cyclophosphamide might affect fertility negatively.

Other treatment drugs may require the mother to stop taking them up to two years before trying for a child. So it is very important for prospective mothers to consult with healthcare professionals well in advance of planning for pregnancy.

Lupus and pregnancy

For women with lupus, pregnancy can present some particular challenges for both mother and child.

While most infants born to mothers with lupus are healthy, it is recommended that the mother should remain under medical care until delivery. This is for three main reasons:

– Premature birth: approximately one third of these babies are premature

– Miscarriage: a higher rate of miscarriage is associated with lupus, particularly in the third trimester

– Lupus flares: about 20-30% of mothers with lupus will experience a flare of lupus symptoms during pregnancy.

While it is best not to take any sort of drug while pregnant, lupus symptoms are usually treated these days. In fact, a lupus flare may be worse for the baby than the drug to treat it! Aspirin and prednisone are both considered safe during pregnancy, while there is debate as to the safety of other drugs.

Miscarriage can occur because approximately 20% of women with lupus have a further complication, significant levels of antiphospholipid antibodies (APS).

APS provokes blood clots in the mother as well as pregnancy complications such as miscarriage, stillbirth, preterm delivery, and preeclampsia. Therefore, lupus sufferers who are pregnant should always be tested for these antibodies. Thankfully, the condition can be treated with low dose aspirin and other safe drugs.

Lupus and IVF 

The good news is that IVF is safe and effective in women with lupus who are in clinical remission. A 2017 study carried out in France was published in The Journal of Rheumatology. They studied 37 women with lupus who underwent 97 IVF procedures. 70%)of the women who underwent IVF delivered at least one healthy child.

Complications were present in 8% of procedures, including four lupus flares and four instances of blood clots. Premature birth occurred in a rather high 37% of pregnancies, highlighting the need for continual medical supervision in these cases.

The researchers commented, “The pregnancy (28%) and live-birth rates (85%) were close to what is expected in the general population. These results confirm that IVF can be safely and successfully performed in women with lupus who are in remission and receiving adequate treatment.”

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