Lupus and pregnancy

Having lupus does not necessarily prevent you from having a child. Thanks to a better understanding of the disease, appropriate treatments, and specialized monitoring, many women with lupus can now carry a pregnancy to term.

However, a pregnancy during lupus requires special preparation and medical monitoring in order to best protect the health of the mother and the fetus.

Preparing for pregnancy

When a woman with lupus wishes to have a child, it is important to discuss this with her medical team before conception. This is because the pregnancy needs to be planned and scheduled due to the associated risks. It is preferable that the disease be well-controlled before becoming pregnant.

A preconception consultation is essential and allows, in particular:

• to assess lupus activity: the existence of active lupus is associated with a poor prognosis for pregnancy;

• to look for possible risk factors, such as high blood pressure;

• to check for organ damage, particularly to the kidneys;

• to carry out or monitor certain biological tests;

• to review current treatments and verify their compatibility with pregnancy.

Note: The preconception visit will be an opportunity to ensure that the patient is immunized against rubella (and to vaccinate her if necessary in the absence of contraindications), to update her vaccinations…

Adapt treatments before conception

Not all medications used in lupus are compatible with pregnancy.

Contraception is essential when certain medications used against lupus can be teratogenic (harmful to the fetus), that is, they can cause malformations in the fetus.

Some treatments must be stopped or replaced early enough before conception, while others can be maintained when necessary to control the disease.

The treatment must allow for the control of lupus while being compatible with a healthy pregnancy.

An international consensus has validated the continuation during pregnancy of the following drugs: hydroxychloroquine; corticosteroid therapy (prednisone or prednisolone) with a dose not exceeding 5 to 7 mg per day; azathioprine; low-dose aspirin (100 mg/day).

It is essential never to stop, modify or replace a treatment on your own because of a desire for pregnancy or the discovery of a pregnancy.

Any changes must be decided in consultation with the medical team.

Note: It is usually recommended to start pregnancy only 12 months after remission from a severe lupus flare (including kidney involvement) and when lupus has been clinically inactive for 6 months.

Increased monitoring during pregnancy

A pregnancy in a woman with lupus generally requires coordinated monitoring by several professionals, including lupus specialists and the obstetric team. The frequency of consultations (which should be at least monthly) and examinations is tailored to each woman's individual situation.

This monitoring allows for the control of:

• lupus activity;

• blood pressure;

• kidney function;

• blood and urine tests;

• the development and growth of the fetus;

• the possible occurrence of obstetric complications.

What are the risks?

The majority of pregnancies do not necessarily present serious complications, but some risks are higher in women with lupus than in the general population.

In particular, there may be an increased risk of:

• lupus flare-up;

• high blood pressure during pregnancy with a risk of pre-eclampsia;

• miscarriage or fetal loss in certain situations;

• fetal growth retardation;

• premature birth.

The level of risk depends in particular on the activity of lupus during pregnancy, any organ damage and the presence of certain autoantibodies, especially antiphospholipids.

Antiphospholipid autoantibodies during pregnancy

Some women with lupus have antiphospholipid antibodies. These are associated with a high risk of thrombosis and obstetric complications.

Their presence is therefore sought and taken into account in the evaluation and monitoring of pregnancy.

The same applies to the presence of anti-SSA/Ro and/or anti-SSB/La antibodies in the mother; this requires particular attention during pregnancy. In rare cases, these antibodies can be associated with neonatal lupus in the newborn, sometimes with cardiac involvement.

When these antibodies are present, the medical team adjusts the monitoring of the pregnancy accordingly.

The importance of multidisciplinary care during pregnancy

The pregnancy should ideally be monitored by a team experienced in pregnancies associated with autoimmune diseases.

Depending on the situation, this team may include, in particular, in addition to the gynecologist-obstetrician and/or midwife, an internist, a rheumatologist or another lupus specialist, and a nephrologist in the event of kidney involvement.

This coordination allows monitoring and treatments to be adapted throughout the pregnancy.

Breastfeeding

Breastfeeding is usually possible, but it is necessary to check with the lupus specialist that the treatments used are compatible.

Key points to remember

Pregnancy is possible in a woman with lupus.

The best conditions are met when the pregnancy is prepared with the medical team, when the disease is well controlled before conception and when appropriate monitoring is put in place throughout the pregnancy.

If you wish to become pregnant, it is recommended to discuss this early enough with the doctor who is monitoring your lupus.

The pregnancy must be monitored from beginning to end by a multidisciplinary team.

Breastfeeding is usually possible; it should be discussed with a specialist.

This information sheet is for general information purposes only. It does not replace a consultation or personalized medical advice for diagnosis and follow-up.

Sources: PNDS Systemic Lupus of Adults and Children (2024) — Reference Centres / RAISE / FAI²R Network; Health Insurance.

Content reviewed and validated by Professor Saïd Norou DIOP, specialist in Internal Medicine, medical advisor for TAHIRAH CARE.