Can women with systemic lupus erythematosus get pregnant? Immunology experts say: Do these 5 things and you can give birth to a healthy baby

Author: Chief Physician of Rheumatology and Immunology Department, Guangdong Provincial People's Hospital: Zhang Xiao, Cui Yang

Systemic lupus erythematosus is an autoimmune disease that occurs most frequently in women of childbearing age (20–40 years old). Its prevalence in my country is approximately 0.03%–0.07%[1].

In the past, when medical standards were low, pregnancy was a contraindication for patients with systemic lupus erythematosus. On the one hand, pregnancy could easily induce the activity or aggravation of systemic lupus erythematosus, and on the other hand, the risk of adverse pregnancy in patients was significantly increased.

Therefore, many female patients worry about whether they can get pregnant and whether it will affect the health of the child. Let’s talk about systemic lupus erythematosus and pregnancy.

Can women with systemic lupus erythematosus get pregnant?

Systemic lupus erythematosus itself does not affect fertility, but some drugs used to control the disease may reduce fertility or have teratogenic effects on the fetus.

Women with systemic lupus erythematosus are more likely to experience adverse pregnancy outcomes during pregnancy, such as recurrent miscarriage, premature birth, and fetal growth restriction.

If the patient is positive for anti-SSA/Ro and anti-SSB/La antibodies, these antibodies can enter the fetus through the placenta and cause neonatal lupus syndrome, which may even endanger the life of the fetus or newborn in severe cases.

During pregnancy, due to changes in hormone levels in the body, 40% to 50% of patients will experience varying degrees of disease activity, with rashes and arthritis being the most common. In addition, after conception, the blood volume in the body increases, and the enlarged uterus often compresses the ureter, greatly increasing the burden on the kidneys of patients with lupus nephritis and leading to kidney damage.

Therefore, pregnancy in women with systemic lupus erythematosus requires careful consideration for both mother and baby. However, having lupus does not mean you lose your right to be a mother. Here is a reminder: if you do the following 5 things, patients with systemic lupus erythematosus can also give birth to healthy babies!

1. Plan your pregnancy

Given that pregnancy in women with systemic lupus erythematosus can lead to disease activity and exacerbation, and even endanger the lives of the mother and fetus, it is crucial to plan the pregnancy.

The condition must be stable for at least half a year, with no damage to important organs, 24-hour urine protein <500 mg, discontinuation of immunosuppressants such as methotrexate, cyclophosphamide, mycophenolate mofetil, leflunomide, and tripterygium wilfordii, and prednisone use <15 mg/d. Only when the above conditions are met can pregnancy be considered. When there is serious involvement of important organs, complications during pregnancy, etc., pregnancy is absolutely prohibited. If you take risks, it may eventually endanger the lives of the mother and the fetus.

With planned pregnancy under the guidance of rheumatologists, obstetricians and reproductive doctors, most patients can safely go through the pregnancy and delivery period and give birth to healthy babies, so there is no need to worry too much.

2. Manage pregnancy well

Prenatal check-ups are very important and necessary, as they can promptly detect situations that threaten the health of the mother and fetus and take effective intervention measures.

It is recommended to follow up once every 4 weeks before 28 weeks of pregnancy and once every 2 weeks after 28 weeks of pregnancy.

Because disease activity can affect pregnancy outcomes, women should visit the rheumatology clinic at least every 3 months for an assessment of disease activity.

After pregnancy, pregnant mothers should not be too anxious, maintain a happy mood, avoid fatigue, pay attention to sun protection when going out, monitor blood sugar and blood pressure at home, follow the doctor's advice, and do not adjust the medication to control the disease on their own.

If you experience abnormal symptoms such as rash, swollen and painful joints, hair loss, foamy urine, etc., you should seek medical attention promptly.

3. Do a good job of postpartum follow-up

Don’t think that everything will be fine after you give birth to your baby. The postpartum period is also a high-risk period for inducing lupus activity, and disease activity still needs to be assessed regularly.

In addition, if a newborn baby is detected with a high titer of relevant antibodies or the patient has given birth to a baby with lupus, even if the baby is asymptomatic at birth, follow-up is required two weeks after birth, every month within six months, and every three months after six months.

4. Breastfeeding

Mothers with systemic lupus erythematosus are recommended to breastfeed, but if they take prednisone at a dose greater than 20 mg/d or an equivalent dose, breast milk produced within 4 hours of taking the medication should be discarded and breastfeeding should resume 4 hours after taking the medication [2].

5. Take good contraceptive measures

SLE patients of childbearing age need to strictly follow contraception. According to the 2015 Perinatal Management Recommendations for SLE Patients in China [2], patients with stable disease, negative antiphospholipid antibodies, no nephrotic syndrome, and no history of thrombosis can take oral contraceptives based on progestin; patients who do not take immunosuppressants in addition to low-dose hormones can use intrauterine contraceptives; all patients can use tool contraception, but they should cooperate with other contraceptive measures to achieve strict contraception.

In conclusion,

As long as the condition is fully assessed before pregnancy, the timing of pregnancy is grasped, and the pregnancy is well managed, most patients with systemic lupus erythematosus can safely give birth to healthy babies.

References

[1] Chinese Society of Rheumatology, National Clinical Research Center for Skin and Immunology, Chinese Systemic Lupus Erythematosus Research Collaborative Group. 2020 Chinese Systemic Lupus Erythematosus Diagnosis and Treatment Guidelines[J]. Chinese Journal of Internal Medicine, 2020, 59(3):172-185.

[2] Expert Group of the Chinese Systemic Lupus Erythematosus Research Collaborative Group. Recommendations for perinatal management of Chinese patients with systemic lupus erythematosus[J]. Chinese Medical Journal, 2015, 95(14): 1056-1060.

About the Author

Zhang Xiao

He is the administrative director and chief physician of the Rheumatology and Immunology Department of Guangdong Provincial People's Hospital, professor and doctoral supervisor of Southern Medical University, vice president of the Rheumatology Branch of the Chinese Medical Doctor Association, chairman of the Rheumatology Branch of the Guangdong Medical Doctor Association, editorial board member or reviewer of magazines such as "Chinese Journal of Rheumatology", "Chinese Journal of Internal Medicine", "Chinese Medical Journal", and "Chinese Journal of Bone and Joint", and deputy editor-in-chief of the Chinese version of ARD. He has been engaged in medical practice for more than 30 years and has been committed to accumulating clinical work, and has considerable insights into severe and difficult rheumatic diseases.