There was a time not too long ago when people with lupus were advised not to become pregnant. But thanks to new treatments and a better understanding of the condition, that is no longer true.

Now, many people who have lupus can have a safe pregnancy and deliver healthy babies.

However, this doesn’t mean that the risks of being pregnant while you have lupus have completely disappeared. Blood clots, decreased kidney function, and premature birth can still happen as a result of becoming pregnant when you have a lupus diagnosis.

Close monitoring of your condition from your doctor and modifications to your lupus treatment may be required to keep you and your baby safe.

In this article, we’ll explain the potential risks of pregnancy if you have lupus, what treatment adjustments may be necessary, and how you can best prepare yourself.

Types of lupus

While systemic lupus erythematosus (SLE) is the most common type of this disease, it’s not the only one.

All forms of lupus are rare, but the following are especially so:

  • Cutaneous lupus, including discoid lupus, affects the skin. It causes rashes or lesions.
  • Drug-induced lupus occurs as an overreaction to certain medications and often goes away when you stop taking the drug.
  • Neonatal lupus is passed from parent to child during birth. Many symptoms resolve over months, but serious heart complications can occur.
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Lupus is a chronic autoimmune condition. When lupus isn’t managed effectively, it attacks healthy tissues in your body, including your organs, blood, and joints.

A lupus flare can affect every system in your body, including your reproductive organs. That’s why anyone who has lupus and gets pregnant is considered “high risk.”

But being high risk doesn’t mean that everyone with lupus will develop pregnancy complications. And not all pregnancies involving a lupus diagnosis are in the same risk category.

Having lupus is more likely to complicate your pregnancy if you:

  • already have kidney involvement (lupus nephritis)
  • have a history of vascular blood clots
  • have irregular blood antibodies
  • recently stopped taking hydroxychloroquine or azathioprin (both are considered safe to take when pregnant)

People who have well-managed lupus and a plan in place with their doctor before they get pregnant will typically have the best outcomes.

Pregnant people should have coordinated care with a maternal-fetal medicine specialist and a rheumatologist in addition to an OB-GYN.

Having lupus can put you more at risk of complications such as:

Less often, more severe complications can occur. These less common complications include:

The stage and severity of your lupus play into your specific risks during pregnancy.

When lupus antibodies affect your kidneys’ function, it’s called lupus nephritis. This is one of the most serious possible effects of lupus. Those with lupus nephritis are at a higher risk of developing high blood pressure and preeclampsia during pregnancy.

People with lupus can also develop antiphospholipid syndrome (APS), also known as Hughes syndrome. If you have APS and get pregnant, your risk for blood clots during pregnancy is higher.

If you’ve had a kidney transplant as a result of lupus, you can still have a healthy pregnancy and deliver your baby safely.

However, since you’ve received an organ transplant, your risk profile is significantly different than others. You should speak with your healthcare team before considering or becoming pregnant.

Certain drugs used to treat lupus aren’t safe to take when you’re pregnant because they can cause birth irregularities.

If you’re hoping or trying to get pregnant soon, it’s essential that you speak with your doctor about adjustments to your medications. Switching to a different medication before pregnancy can give you time to adjust and cut your risk of having complications later on.

Drugs that are considered unsafe during pregnancy include:

Corticosteroids, such as prednisone, which are often prescribed to treat lupus, can be safe during pregnancy with a doctor’s approval. However, these drugs will be prescribed at their lowest recommended dosage while you’re pregnant.

Antimalarial drugs, including hydroxychloroquine, are considered safe and can typically be continued during pregnancy.

The Centers for Disease Control and Prevention (CDC) recommends that you avoid getting pregnant until your lupus is managed or in remission for a minimum of 6 months.

Like other autoimmune diseases, lupus has flares, or periods where your symptoms are worse. If you get pregnant while you’re having an active lupus flare, the stress on your kidneys can cause serious complications.

These include:

  • increased blood pressure
  • blood clots
  • miscarriage

Taking prenatal vitamins and eating a healthy, nutritious diet in the months prior to your pregnancy can help prevent lupus flares while you’re carrying your baby.

Lupus diagnosis

Are you pregnant or looking to become pregnant but unsure if you have lupus?

It’s possible to have lupus and not know. Because of this, it’s important to keep track of any new or troubling symptoms and communicate with your doctor.

Lupus is a notoriously difficult disease to diagnose because it shares many symptoms with other conditions. It has some hallmarks, such as a butterfly-shaped rash across the face, but not everyone will experience these.

Learn more about signs and symptoms:

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Pregnancy itself isn’t definitively connected to an increase in lupus flares.

However, changes to your medication as well as additional stress on your body during pregnancy can cause flares while you’re carrying your baby.

You may be more likely to experience a flare if your disease was particularly active right before conception and in the months following delivery.

This can be confusing and stressful, especially because some of the typical signs of pregnancy can resemble the symptoms of a lupus flare.

Lupus flare symptoms are usually similar to the condition’s typical symptoms but worse in severity. You may even experience new symptoms.

These include:

This is where it’s critical to be in close communication with your healthcare professionals during pregnancy. They will speak with you to establish a baseline idea of what “normal” symptoms will be for you.

If you have an increase in your symptoms during your pregnancy, your doctor may collect and test a urine sample to look out for signs of preeclampsia, such as protein in your urine.

You shouldn’t force yourself to be in a constant state of high alert, causing unneeded stress. But you should take inventory of your symptoms, writing them down if that helps you keep track.

Preeclampsia and decreased kidney function during pregnancy need to be treated right away for your safety and for the health of your baby.

Some people are able to deliver vaginally with lupus. But since your risk of hypertension, anemia, and sepsis are higher, your chances of needing a cesarean section (C-section) are higher, too.

Talk with your doctor about your delivery options and create a labor and delivery plan in the weeks prior to your due date.

Most people with lupus are able to breastfeed. But every baby’s feeding journey is different.

If your baby is born early (due to preeclampsia or other complications) and has a low birth weight, you may be advised to supplement breastfeeding with formula.

If you develop hypertension during pregnancy, you may need to continue taking blood pressure medication for up to 6 weeks after your delivery.

Prior to your delivery, you can make a plan with your doctor about resuming medications that you stopped taking prior to and during your pregnancy. Some of these are still unsafe to take while breastfeeding, as they can pass to your baby.

You may not be able to resume your former regimen right away.

Pregnancy outcomes for people with lupus are better than they’ve ever been before. But that doesn’t mean that the risks associated with lupus and pregnancy have completely gone away.

High blood pressure, premature birth, and anemia are some of the possible complications of pregnancy if you have lupus.

Having certain preexisting symptoms, including kidney involvement and irregular blood antibodies, can increase your lupus-related pregnancy risks.

It’s important to consult your healthcare team while planning a pregnancy and involve specialists. You may have to change your medications, some of which are unsafe for the baby or may increase your risk of serious complications.

Getting your lupus managed or in remission prior to pregnancy is important. Together with your doctor, you can create a treatment plan that’s safe for you and your baby in order to have the healthiest possible pregnancy.