Systemic lupus erythematosus (SLE) and Pregnancy

What is systemic lupus erythematosus (SLE)?

SLE is an auto-immune disease where your immune system attacks your own tissues.  SLE can damage your skin, joints, kidneys, brain, lungs and blood vessels.

Women of childbearing age are the most common group affected by SLE, so it’s a condition I see quite often amongst my pregnant patients.

 

Lupus disease colin walsh

What effect will SLE have on my pregnancy?

Most women with SLE can safely get pregnant and have a healthy baby.  However, all pregnant women with SLE are “high risk,” meaning the chance of complications is significantly higher.

Your individual risk will depend on:

    • Which of your organs are affected
    • How well is your SLE controlled
    • The medications you take

Overall, there is an increased risk of miscarriage, pre-eclampsia, premature birth, stillbirth and fetal growth restriction (an unhealthily small baby).

Some women with SLE also carry specific antibodies in their blood which increase the risk of blood clots or, rarely, can seriously affect the baby’s heart rate.  The baby can also have a form of lupus at birth.

 

What should I do if I want to have a baby?

Firstly, I strongly recommend pre-pregnancy counselling to any woman with SLE.  This is essential if lupus has affected your kidneys, heart or lungs, as pregnancy may then be especially risky.

You may need to adjust your medications prior to pregnancy.  You will be able to safely continue some anti-inflammatories, steroids and immunosuppressants. However, many lupus medications are not recommended while you are pregnant.  It’s always best to adjust your medications before you conceive.

During pregnancy, you need to be looked after by an obstetrician with a lot of SLE experience, ideally a Maternal-Fetal Medicine specialist.  This is due to the wide spectrum of potential complications, medication safety issues and the need for close monitoring of the unborn baby with tertiary-level ultrasound scans.