For decades, women with lupus were discouraged from having children. Now, a doctor at OMRF says most women with lupus can safely have a baby—if they’re willing to plan.
“In the 1950s, doctors advised lupus patients to not become pregnant or even to terminate pregnancies because of the potential health risks to mothers and babies,” said Eliza Chakravarty, M.D., who specializes in helping women with lupus have children. “Back then, the maternal death rate for women with lupus was about 17 percent.”
But that’s changed dramatically, she said. Doctors know more about the disease, how to treat it and how medications can affect an unborn child. A recent study found that pregnancy is safe for more than 80 percent of women with lupus.
Lupus is a chronic autoimmune disease with no cure. It causes the immune system to become overactive and attack the body’s own cells and tissues with the same ferocity it attacks foreign invaders like bacteria or viruses. Symptoms include fatigue, fever, rashes and joint pain.
Controlling the disease is the first priority before becoming pregnant, said Chakravarty. Patients need to start a pregnancy when they’re healthy to give both child and mother the best chance at coming through unscathed. It can take more than a year to get healthy enough for pregnancy and, ideally, that level of health should be maintained for at least 6 months prior to conception, she said.
“The women I see are most concerned with whether the disease or the medicine they’re using to control the disease will harm the baby,” she said. “That’s why planning is so important. The patient needs to be healthy while using medications that carry the lowest risk of birth defects.”
If a patient has a “flare up” of the disease while pregnant, they still need treatment, Chakravarty said. Much as mothers pass on what they eat and drink to the fetus, the effects of inflammation caused by lupus can influence the baby.
“As for medication, birth defects must be understood in context. In completely healthy people who aren’t taking any medications during pregnancy, the risk of birth defects is about 5 percent,” she said. “The majority of birth defects are genetic. Less than 1 percent are caused by medications.”
Many are concerned about passing the disease on to their children, Chakravarty said.
“Lupus results from a combination of genetic and environmental factors, so even if a mother passes on the genes for lupus to a child, there’s no guarantee they will encounter the environmental trigger that ‘turns on’ the disease,” she said. “Even in identical twins, who share identical DNA, if one twin has lupus, the other twin only has a 30 percent chance of also having lupus.”
This is good news for lupus patients interested in starting a family, though it does require work, Chakravarty said.
“There’s nothing that makes me happier than seeing a patient get to fulfill her dream of motherhood, especially when she thought it was out of reach,” she said. “For me, the reward comes when I get to take that healthy baby and hold it in my arms.”