Pregnancy and Lupus

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Pregnancy and Lupus

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 that pregnant lupus patients ask 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 25% of lupus pregnancies end in unexpected miscarriages or stillbirths. Another 25% 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% 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 3–6 months old and does not recur. About one-half of babies with neonatal lupus are born with a heart condition. 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 high-risk 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 can occur to any woman who has been pregnant, 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.
If you are taking corticosteroids, you may not be able to produce enough milk.
Some medications can pass through your breast milk to your infant. It will be up to your doctor to decide if breastfeeding is safe if you are taking any of these medications.
Because breastfed infants tend to eat more frequently than do bottle-fed infants, breastfeeding can be very tiring. You may want to switch to a bottle and formula if breastfeeding becomes too tiring.
Be confident, though, that whichever method you choose to use to feed your baby, it will be the right decision for everyone concerned.

Before you leave the hospital, discuss birth control options with your doctor. Because it would be unwise for you to become pregnant again soon after giving birth, be sure to use an effective birth control method. REMEMBER: You can get pregnant before your period begins again; also, breastfeeding and withdrawal of the penis before ejaculation are not effective birth control methods.

Caring For Yourself

Keep all of your appointments with your primary doctor and your obstetrician.


Get enough rest. Plan for a good night’s sleep and rest periods throughout the day.


Eat a sensible, well-balanced diet. Avoid excessive weight gain. Have your obstetrician refer you to a registered dietitian if necessary.


Take your medications as prescribed. Your doctor may have you stop some medications and start or continue others.


Don’t smoke, and don’t drink alcoholic beverages.


Be sure your doctor or nurse reviews with you the normal body changes that occur during pregnancy. Some of these changes may be similar to those that occur with a lupus flare. Although it is up to the doctor to determine whether the changes are normal or represent the development of a flare, you must be familiar with them so that you can report them as soon as they occur.


If you are not sure about a problem or begin to notice a change in the way you feel, talk to your doctor right away.


Ask your doctor or nurse about participating in childbirth preparation and parenting classes. Although you have lupus, you have the same needs as any other new mother-to-be.
 

Adminஐﻬ:
March 16, 2007


Pregnancy Risk: Preeclampsia Linked To Elevated Autoantibodies

 Women who develop preeclampsia during pregnancy are more likely to develop certain dangerous autoantibodies than women with normal pregnancies, and these autoantibodies are still present two years after childbirth in about 20 percent of women who had the disorder, scientists from the University of Pittsburgh report in the March issue of Hypertension, the journal of the American Heart Association.

Also known as toxemia, preeclampsia affects some 5 percent of pregnancies and is a leading cause of maternal and fetal illness and death, particularly in developing nations. Signs include high blood pressure, swelling of the ankles and the presence of protein in the urine. The condition typically appears after the mid-point of pregnancy.

The only effective treatment is immediate delivery, which can be dangerous for the baby if it is too early. Untreated, the condition can lead to organ failure, coma and death. Preeclampsia also has been linked to an increased lifetime risk for heart disease.

"Further study is required to determine whether the presence of these autoantibodies could be an early marker for preeclampsia risk, but early data are promising," said Carl A. Hubel, Ph.D., the study's lead author and assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. "Learning more about these autoantibodies also might enable us to identify a subset of women who are at greater risk for heart disease later in life, and give us a closer understanding of what causes preeclampsia."

For most women, the autoantibodies eventually go away after pregnancy. "But in some, they persist or reappear, consistent with other data showing that many of the risk factors for preeclampsia are the same as those for cardiovascular disease," added Dr. Hubel, who also is an associate investigator at the university-affiliated Magee-Womens Research Institute.

Autoantibodies are immune system proteins that attack the body's own cells instead of microorganisms that represent a real threat, such as viruses, bacteria or other toxins. Dr. Hubel and his colleagues studied the development of autoantibodies capable of activating the angiotensin II type 1 receptor (AT1-AA). The AT1 receptor is part of an amino acid group that works within cells to maintain healthy blood vessels and manage inflammation. Too much AT1 receptor activation, such as takes place when the autoantibodies are present, can lead to high blood pressure and inflammation.

"These antibodies are similar to antibodies in other conditions, such as those related to the autoimmune thyroid disorder Grave's disease," said Dr. Hubel. "These kinds of antibodies also are related to high blood pressure, which is one of the signs of preeclampsia. Women with a history of preeclampsia have a substantially higher cardiovascular risk later in life, compared to women who experienced normal pregnancies."

While the cause of preeclampsia remains unknown, evidence is mounting that the disorder relates to poor formation and placement of the placenta combined with underlying maternal factors including insulin resistance, obesity and inflammation that are magnified during the physiological stress of pregnancy.
Elevated levels of AT1-AA are evident in nearly all women with preeclampsia, the researchers report. Blood samples from 29 women with preeclampsia and 35 women who had normal pregnancies at Magee-Womens Hospital of UPMC in Pittsburgh and Massachusetts General Hospital in Boston were studied. The samples were collected between six months and two years postpartum to allow for stabilization of normal, pregnancy-induced cardiovascular changes.

"AT1-AA were detected in 17.2 percent of postpartum women who had developed preeclampsia, as opposed to 2.9 percent of postpartum women whose pregnancies were uncomplicated," said Dr. Hubel.
In addition to Dr. Hubel, study authors are Gerd Wallukat, Ph.D., Max Delbruck Center for Molecular Medicine, Berlin; Myles Wolf, M.D., and Ravi Thadhani, M.D., both of Massachusetts General Hospital; Augustine Rajakumar, Ph.D., James M. Roberts, M.D., and Nina Markovic, Ph.D., all of the University of Pittsburgh and Magee-Womens Research Institute; and Florian Herse, M.D., Friedrich C. Luft, M.D., and Ralf Dechend, M.D., of the Franz Volhard Clinic, Berlin.
Funding for the study was provided by the Massachusetts Institute of Technology, Magee-Womens Hospital of UPMC, the National Institutes of Health and the American Heart Association.
Thank you Karyl, as always.

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~Lupus Pregnancy - Need For Perfect Planning
Lupus pregnancy is an autoimmune disease that causes the immune system to attack healthy tissue. The causes of lupus are unknown. Any person can contract Lupus, but it is most commonly found in women. Lupus is a disease that strikes predominantly young women in the reproductive years.

~What Can Be The Extent Of Risk?
The risks of pregnancy problems in lupus patients are real and can affect both the mother and the fetus. About ten percent of pregnancies currently end in miscarriage, due to this. The first trimester losses appear either to have no known cause or to associate with signs of active lupus. But 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 in Lupus pregnancy, you must carefully plan your pregnancy. Your disease should be under control or in remission, before the 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 an obstetrician who has experienced managing high-risk pregnancies monitors such a pregnancy.

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. A Cesarean section is advisable at such situations. One problem that can affect a pregnant woman in Lupus pregnancy 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.

The most important question asked in Lupus pregnancy 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. As your pregnancy progresses, the doctor will regularly check the baby's heartbeat and growth with sonograms. If not planned properly, about 70 percent of such pregnancies end up in unexpected miscarriages or stillbirths. Another 30 percent may result in premature birth of the infant. So, plan properly and follow all the necessary steps for a healthy outcome and to avoid Lupus pregnancy complaints.

Adminஐﻬ:


Beating Lupus Pregnancy And Becoming A Mother

Lupus pregnancy occurs to those unfortunate women suffering from Lupus erythematosus. It is a disease of the immunity system in which the immunity system turns against healthy tissues of the body. It can happen to anybody but non caucasian women of reproductive age are more prone to this disease.

~Reasons And Symptoms

Medical science is yet to give a solid reason for Lupus erythematosus. It affects any part of the body, but most often harms the heart, joints, skin, lungs, blood vessels, liver, kidneys and nervous system. In pregnant woman, it turns fatal as it causes miscarriage in the first trimester. Statistic shows that this disease is the reason for ten percent of miscarriages during pregnancy. In fact, miscarriage in the first trimester without any reason can be an indication of Lupus erythematosus. There are certain symptoms that one should be on the lookout for; they occur before a lupus flare starts. The symptoms are: increased fatigue, pain, rash, fever, abdominal discomfort, headache and dizziness. A woman planning to conceive should immediately consult her doctor when these symptoms start. Corticosteroids are often used to suppress the lupus flares.

~Avoiding Future Complication


If the disease is diagnosed, the woman should wait before trying to conceive again. It is better that the next pregnancy is planned from the beginning after consulting a gynaecologist who has experience of handling high risk birth and looking for a hospital which has an emergency neo natal unit. Only after the disease is under control should she become pregnant.

The outcome of a lupus pregnancy can be happy if the mother takes certain precautions. She should regularly consult with her doctor to monitor the growth of the fetus. In most case, doctors avoid vaginal birth and opt for caesarean birth. Sometimes during the first or the second trimester, the lupus flares may resurface but they can be treated with the right doses of medicine. Sometimes, the disease may result in premature birth and so the mother should train herself beforehand to face any kind of emergency.

~Risk Factor For The Baby

Generally lupus pregnancy does not stand in the way of having a healthy and normal baby. Still, one should be careful during and after pregnancy period. Regular check ups of the mother through sonogram will show the baby’s progress and heartbeat. Sometime there is an increase in blood pressure or protein in the urine or both and the situation is known as toxemia of pregnancy (or pre-eclampsia or pregnancy-induced hypertension). In such cases, immediate delivery of the baby is necessary or else mother and child are both in grave danger. Lupus pregnancy does not cause mental retardation or deformities in the new born baby. However, if proper planning is not done, statistic shows that seventy percent of lupus pregnancy may end in miscarriage or still birth. There is also a thirty percent chance of babies being born prematurely. Rarely, babies may be born with neonatal lupus. Rashes developing in the first few weeks stay for first six months and then disappear.

Pregnancy is a blessing in a woman’s life. All women want to enjoy the experience at least once in their lifetime. So with careful planning and awareness a woman can live through lupus pregnancy and still be mother to a healthy baby.

Lupus pregnancy is one of the many pregnancy problems. When faced with such a situation consult your pregnancy doctor immediately for advice and treatment options. Pregnancy planning can help avoid many complications and risks. Pregnancy Period is a free online resource where you can look for answers to your questions related to pregnancy and related issues.

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