Considering pregnancy and have lupus? Plan ahead

Like many autoimmune disorders, lupus (systemic lupus erythematosus, or SLE) disproportionately affects women during child-bearing years. Lupus is one of more than 80 autoimmune illnesses that affect an estimated 23 million people in the US — and nearly 350 million people worldwide. If you have lupus or another autoimmune illness and you’re planning to have kids, it’s safest to think ahead.

Years ago, people with lupus or other autoimmune disorders were advised to avoid pregnancy. The thinking was that it was simply too risky for mother and fetus. That’s no longer true: in most cases, following expert guidelines now available can make a successful pregnancy possible. These guidelines explain good practices for a range of family planning issues. Below, we answer several common questions about fertility, pregnancy, birth, and breastfeeding.

How might lupus or its treatment affect my fertility?

About 90% of people with lupus are biologically female, and the disease tends to begin between the ages of 15 and 35. So, family planning is a crucial part of lupus care.

Doctors once believed that active lupus interfered with fertility so much that pregnancy was unlikely. While this myth was debunked long ago, people with lupus may take longer than expected to become pregnant. This is more likely if you have active disease requiring aggressive treatment, or if you have certain antibodies (called antiphospholipid antibodies) in your blood.

Your prenatal provider or rheumatologist may recommend that you see a maternal fetal medicine specialist experienced in taking care of pregnant people with fertility issues to fully review your situation.

For people with lupus who experience infertility, in vitro fertilization may be a good option. Because certain medicines, such as cyclophosphamide, may reduce fertility, your doctor may recommend adjusting these.

Egg freezing is another option. It can be done before starting medicine that reduces fertility, or to save younger, healthier eggs for the future in case pregnancy must be delayed for a while.

Will I need to change my treatment before pregnancy?

This depends on which medicines you take and how well controlled your illness is. Good control for at least three to six months before getting pregnant is ideal. An unplanned pregnancy can put both you and the pregnancy at risk.

…continued

swipe to next page