Management of Lupus in Pregnancy: Birth Injury Prevention

In the 1970s, women with lupus were often advised against becoming pregnant because of associated complications that can make pregnancies with lupus dangerous to both mothers and babies. Today, doctors recognize that with proper medical oversight and careful timing, most women with lupus can have a successful pregnancy (1). However, it is important to note that pregnancies involving lupus should be classified as high risk, and doctors should provide extensive prenatal monitoring and care in order to ensure the health of the mother and prevent the baby from sustaining birth injuries

When can a woman with lupus have a safe pregnancy?Pregnant woman

Although all pregnancies involving lupus are relatively high risk, there are certain circumstances under which they are more risky than others. The CDC recommends that women only try to become pregnant if their lupus has been under control or in remission for at least six months. When lupus is active, pregnancies are more likely to result in miscarriage, stillbirth, or other serious problems (2). 

Additionally, pregnancies are more risky for women with lupus who also have or have had the following associated health issues (2, 3):

  • Hypertension (high blood pressure) or a history of preeclampsia (high blood pressure that emerges for the first time during pregnancy)
  • Lung disease
  • Kidney disease or failure
  • Heart failure
  • A stroke within the past six months
  • Antiphospholipid antibodies
  • Low platelets
  • Blood clots

It is strongly recommended that women with lupus consult a doctor three to six months before they start trying for a baby. At this time, the doctor can provide an assessment of their health and estimate their level of risk. Doctors may also recommend discontinuing or changing the dosage of certain medications that can interfere with pregnancy (3). 

How is lupus managed during pregnancy?

Pregnant women with lupus should see an obstetrician who is qualified to manage high-risk pregnancies (such as a maternal-fetal specialist) as well as a rheumatologist. 

Once pregnant, women with lupus should have the following laboratory tests, according to the Lupus Foundation of America (these are in addition to other routine prenatal tests):

  • Urinalysis 
  • Complete blood count
  • Blood tests to assess liver and kidney function
  • Antiphospholipid antibodies
  • Anti-SSA/Ro and Anti-SSB/La antibodies
  • Anti-DNA antibodies
  • Complement levels

Expectant mothers with lupus should see their rheumatologist at least once in each trimester. If they experience a lupus flare-up, more frequent visits will be needed. When flares occur, doctors may recommend treatment with prednisone, which should not cross the placental barrier (i.e. affect the baby) as long as it is given at a low dose (3). 

What pregnancy issues are associated with lupus?

Compared to the general population, women with lupus are more likely to experience pregnancy complications such as the following (2, 3): 

  • Lupus flare-ups: Even if a woman conceives after being in remission for a while, she may still experience a lupus flare-up during pregnancy. These flare-ups can easily be mistaken for normal pregnancy symptoms, such as swelling and rashes. Therefore, it is important to frequently see a doctor in order to determine whether lupus is active, and receive treatment if necessary.
  • Preeclampsia: This is when a pregnant woman has a sudden increase in blood pressure after 20 weeks of pregnancy, along with protein in the urine (proteinuria). Approximately 2 in 10 pregnant women who have lupus also develop preeclampsia (4). Symptoms may include severe headaches, blurry vision, sudden weight gain, swelling, dizziness, and stomach pain. Preeclampsia often means the baby will need to be delivered early. 
  • HELLP syndrome: The ‘HELLP’ acronym stands for hemolysis (early breakdown of red blood cells), elevated liver enzymes, and low platelets. It is very similar to preeclampsia; some consider it a variant while others consider it a distinct condition.
  • Antiphospholipid antibodies: The presence of antiphospholipid antibodies can cause blood clots and disrupt placental function. This can deprive the baby of nutrients and oxygen, and an early delivery will likely be recommended.
  • Kidney issues: Active lupus can cause impaired kidney function. Symptoms of this include swelling in the legs, ankles, and feet. 
  • Intrauterine growth restriction (IUGR)/fetal growth restriction (FGR): There are a number of factors that can cause IUGR in pregnancies involving lupus, including those discussed above. Babies with IUGR may need to be delivered early.
  • Miscarriage and stillbirth: These issues are more common in women with lupus; the major risk factors are fetal loss in a previous pregnancy and high levels of antiphospholipid antibodies.
  • Premature birth: Women with lupus are more likely to deliver their babies prematurely. 
  • Neonatal lupus: The Lupus Foundation of American notes that, “Neonatal lupus is not true lupus; it is a rare condition associated with anti-SSA/Ro and/or anti-SSB/La antibodies from the mother acting upon the fetus.” Babies with neonatal lupus may have liver problems, low blood cell counts, or rashes. However, these symptoms usually disappear after six months. The most serious potential complication is congenital heart block, which may necessitate the insertion of a pacemaker.

Lupus and birth injuries: legal helpReiter & Walsh, PC | Birth Trauma Attorneys

Today, many women with lupus have safe pregnancies and healthy babies. However, it is important that doctors recognize that these are high-risk pregnancies, and that precautions must be taken in order to prevent and promptly manage any complications that may arise. 

Failure to provide standard of care for a patient with lupus is negligence, and if this negligence causes harm to the mother and/or baby, it is medical malpractice. Some of the complications associated with lupus, such as preeclampsia, IUGR, and preterm birth, can cause serious birth injuries and forms of permanent brain damage in the baby.

If your baby has a condition such as hypoxic-ischemic encephalopathy (HIE) or cerebral palsy (CP), and you believe this may have been caused by mismanagement of lupus and/or associated complications during pregnancy, please contact the attorneys at ABC Law Centers. We focus on birth injury cases, and we have the knowledge and experience necessary to win. Our case results, awards, and client testimonials all attest to our success, and clients pay nothing unless we obtain compensation for them. Reach out today for a case evaluation, which is free of any charge or commitment to pursue a case. 

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Sources

  1. Lupus and Pregnancy. (n.d.). Retrieved July 26, 2019, from https://www.hopkinslupus.org/lupus-info/lifestyle-additional-information/lupus-pregnancy/ 
  2. Having a Healthy Pregnancy with Lupus | CDC. (n.d.). Retrieved July 26, 2019, from https://www.cdc.gov/lupus/basics/pregnancy.htm 
  3. Planning a pregnancy when you have lupus. (n.d.). Retrieved July 26, 2019, from https://www.lupus.org/resources/planning-a-pregnancy-when-you-have-lupus 
  4. Clowse, M. E. (2007). Lupus activity in pregnancy. Rheumatic Disease Clinics of North America, 33(2), 237-252.

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