Thursday, June 6, 2013

Lupus and Pregnancy - What to Consider Before You Decide to Have a Baby

If you are living with lupus and contemplating having a baby there are a lot of questions you are going to want to address.

Here are the top concerns I get emailed about, and those that I will answer in my mini-series on lupus and pregnancy. (For more information right away, please visit my site below).

    -Is it safe to have a baby if I have lupus?

    -Will my baby get lupus too?

    -Will getting pregnant cause a lupus flare? When is the best time to get pregnant?

    -Can my baby be born naturally?

    -Can I breast feed?

    -Is there a greater likelihood of miscarriage?

    -What is toxemia of pregnancy?

    -Is there something I should do to help the pregnancy process?

    -I am afraid I will get a flare from being pregnant. What if I can not take care of my child?

This article will address some of the most common questions addressed above. (Stay tuned for part 2 to follow).

1. Is it safe to have a baby if I have lupus?

During the early seventies, women were told if they had lupus they should not get pregnant. Since those days, treatment and support for lupus patients have changed however it is still an important question that must be addressed, looking at your specific illness, needs and risk factors.

Because lupus is a disease that strikes young women, predominantly in their childbearing years, pregnancy is a big concern as you well imagine. However, for most women living with lupus a successful pregnancy is possible. That being said there are 'pregnancy dos and don'ts' that you must follow during your pregnancy to avoid complications.

Here are some suggestions to support yourself before and during pregnancy:

    Carefully plan your pregnancy, taking into consideration all of your needs. (For example, sufficient time off of work, support taking care of your child, sufficient time for rest, daily chores support, a house cleaner to do the most strenuous work, sufficient funds to allow for extra costs such as a nanny for the first few months etc.)

    Ideally, it is best that your lupus be under control or in remission for at least 6 months before you get pregnant.

    Have a strong support system in place you can rely on (For example, during a postpartum period, a stressful period or just coping with life changes etc.).

    Keep a diligent record of your condition, symptoms and health fluctuations.

    Plan your calendar in advance to ensure all of your necessary activities are taken care of well in advance to avoid stress. (For example, preparing the baby's room, collecting the necessary baby items such as car seats, strollers, etc. well in advance to avoid undue stress and rushing).

    Create a stress-free process as much as possible to support and maintain a healthy immune system, including dietary needs. (For example, an organic foods delivery system is a great way to avoid regular grocery trips).

    Take extra care of your health needs, following a nutritious healthy lupus diet, with supportive supplements (such as essential fatty acids to naturally reduce inflammation) and prepare your meals in advance (store extra meals in the freezer) to avoid extra work in the kitchen.

    Avoid environmental toxins (such as painting fumes etc.) and be extra careful with situations that don't support wellness (such as cleaning products, second hand smoke or other noxious items).

Lupus pregnancies are considered high risk!

Being pregnant while living with lupus is considered a high-risk pregnancy. As mentioned above, it is especially important that you find an obstetrician (OB) who is experienced in managing high-risk pregnancies and someone you feel confident in. This person may or may not be your regular OB; however having an expert on hand (at minimum for a second opinion) is highly advisable

The biggest risk to your baby is premature birth. Births before 36 weeks are considered premature.

Here are some statistics concerning the risks of pregnancy and lupus:

About 50% of lupus pregnancies end before 40 weeks (9 months), usually because of the complications previously discussed.Babies born after 30 weeks, or weighing more than 3 pounds, usually do well and grow normally Premature babies may have these problems, but in modern neonatal units they can be easily treated:

-Difficulty breathing

-Developing jaundice

-Becoming anemic

Even babies as small as 1 pound, 4 ounces have survived and have been healthy in every way; but the outcome is uncertain for babies of this size. There is one congenital abnormality that occurs only to babies of lupus mothers (neonatal lupus, described below)There is no unusual frequency of mental retardation in babies of lupus mothers

Of course, the most important question lupus patients as is: will my baby be ok? The answer is, in most cases, yes. Babies born to women living with lupus have no greater chance of birth defects or mental retardation than any other baby.

Approximately 3% of babies born to moms with lupus will also have neonatal lupus. This will include temporary rash and abnormal blood counts. This usually will disappear by the time the child is between 3 and 6 months old and will not recur.About 50% of babies with neonatal lupus are born with a heart condition. This condition is typically permanent and treatable with a pacemaker. You should discuss this possibility with your doctor.About 33% of people with lupus have an antibody known as the anti-Ro, or anti-SSA, antibody.About 10% of women with anti-Ro antibodies-about 3% of all women with lupus-will have a baby with a syndrome known as "neonatal lupus."

Neonatal lupus is not SLE. Neonatal lupus consists of:

-A transient rash

-Transient blood count abnormalities

-Sometimes a special type of heart beat abnormality. If the heart beat abnormality occurs, which is very rare, it is treatable but it is permanent.

Neonatal lupus is the only type of congenital abnormality found in children of mothers with lupus.

For babies with neonatal lupus who do not have the heart problem, there is no trace of the disease by 3-6 months of age, and it does not recur. Even babies with heart beat abnormality problems grow normally. If a mother has had one child with neonatal lupus, there is about a 25% chance of having another child with the same problem.

There is only a small chance that the child will develop systemic lupus erythematosus later in life.

3. Will getting pregnant cause a lupus flare?

Flares during pregnancy are most common during the first or second trimester or during the first few months following delivery.

Stress (both chronic and acute) plays a significant role in increasing your risk of a flare, so you must do all that you can to manage it.

The presence of lupus nephritis before conception also increases the chance of having complications during pregnancy. These concerns should be discussed with your doctor, as each person's situation and physical constitution is very different.

Most flares that do occur are mild and treated easily with corticosteroids.

The most common symptoms of these flares are:




Remember, in some situations a flare is difficult to differentiate between lupus and pregnancy.

Certain abnormalities in lupus laboratory tests may be due to pregnancy rather than to lupus:

Approximately 33% of women with lupus will have a decrease in platelet count during pregnancyAbout 20% of women with lupus will have an increase in protein in the urine, or new occurrence of protein in the urine

These levels usually recover after delivery

4. When Is The Best Time To Get Pregnant?

The answer is simple: when you are at your healthiest.

Women in lupus remission have much less trouble than do women with active disease. It is important to remember that woman who conceive after 5 to 6 months of remission are less likely to experience a lupus flare than those who get pregnant while in a current flare.

Good health rules are essential:

-Eat well; you must follow a healthy diet for lupus (see site below for a specific diet for lupus guidelines)

-Take medications as prescribed

-Visit your doctor(s) regularly

-Don't smoke

-Don't drink

-Certainly don't use recreational drugs

-Listen to your body and follow its needs, (pushing through pain or fatigue is not advised, get the rest your body needs)

When you are in remission there is every reason to be hopeful that you can conceive a healthy child and maintain your health, especially if you are diligent with your health and get the support of medical (and alternative) health specialists.

You must support your body and immune system with a proper diet for lupus which will not only support your health, but that of your future child. To learn more about at lupus diet dos and don'ts please visit the site below.

Your delivery should also be in a hospital, so you have access to specialized care and equipment you or your baby may need.

Lupus pregnancies are considered high risk. You should not attempt home delivery or be overly concerned about natural delivery, since complications during delivery can occur.

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