Lupus and Pregnancy
Here we go again with the age old topic....Pregnancy...I've started posts like this before on here...I went back to find them actually to see if my answer was in there, but for some reason I can't find them.??
Anyway, has anyone here with Lupus had a successful pregnancy? Has anyone here with Lupus NOT had a successful pregnancy? And also has anyone here had pregnancy with kidney involvement? I don't have Lupus Nephritis or anything, but from time to time my bloodwork will show a very small amount of proteinuria. Then the next time I get bloodwork it mysteriously goes away. Either way, my rheumie seems to feel that although I don't have Nephritis the fact that I do spill a small amount of protein puts me at significant risk for getting Lupus Nephritis during pregnancy and going into renal failure. Of course that would be the worse case scenario. My lupus is okay. I mean I'm on plaquenil and a multivitamin and that's it. No heavy heavy drugs. I just really am not sure what to do. I would love to hear any stories ESPECIALLY if you've had kidney involvement. I also have a positive double-stranded DNA results sometimes too. For those of you who know what that is...Thanks alot for you help.
Pregnancy with Lupus is possible and giving birth to a healthy baby is also possible. However, doctors consider all pregnancies with lupus as "High Risk". High risk" is a term commonly used by obstetricians to indicate that solvable problems may occur and must be anticipated.
Many women are concerned about having a flare during pregnancy, flares most often occur during the first or second trimester, or during the two months immediately after delivery. Most of the flares tend to be mild. The most common symptoms of these flares are arthritis, rashes and fatigue. Approximately 33 percent of lupus patients will have a decrease in platelet count during pregnancy, and about 20 percent will have an increase in or new occurrence of protein in the urine.
However, Lupus nephritis is one of the most serious manifestations of SLE. Histological evidence of lupus nephritis is present in most patients with SLE, even if they do not have clinical manifestations of renal disease. The symptoms are generally related to hypertension, proteinuria, and renal failure.
But, with the advent of more aggressive immunosuppressive and supportive therapy, renal and patient survival rates are improving.
The problem is that doctors usually advise their patients with Lupus Nephritis to avoid pregnancy because it may aggravate renal disease, especially in the presence of active lupus nephritis, nephrotic syndrome, severe hypertension, or serum creatinine levels elevated to more than 2 mg/dL.
Here are some statistics that I found:
" Patients with lupus nephritis have a 50-60% chance of renal flare during pregnancy if they conceive during active disease. Patients with well-controlled SLE who conceive after a 3- to 6-month period of remission have a 7-10% chance of renal flare. Pregnant patients with lupus nephritis are prone to preeclampsia. Preexisting hypertension and antiphospholipid antibody syndrome are the 2 most common predisposing factors to preeclampsia. Severe flares during pregnancy may cause acute renal failure and maternal and fetal death."
It is recommended that the Obstetrician and the Rheumatologist closely monitor pregnant patients with SLE, aggressively treat exacerbations, and carefully avoid administering teratogenic drugs (Drugs which cause malformations to the baby are known as teratogens. Other drugs that are dangerous may still cause neurological and behavioral problems without causing malformed anatomy in the baby. A teratogen is an agent that can disturb the development of the embryo or fetus. Teratogens can halt the pregnancy or, alternatively, permit the pregnancy to proceed but produce a congenital malformation (a birth defect). Classes of known teratogens include radiation, maternal infections, chemicals, and drugs).
I hope that I've answered some of your questions
Peace and Blessings
I have lupus nephritis and my nephrologist does not discourage me from getting pregnant (although I'm getting over a flare right now and with meds it's not advisable). Before my flare and in the future my nephrologist and rheumatologist have not discouraged me from getting pregnant. They told me I will be monitored extremely closely. So talk to all your doctors. But saysusie is right that most will discourage a woman with nephritis against getting pregnant. You have to know how you feel about it too. I'll admit even through they say I can get pregnant in the future I'm a little scared. As much as I want to carry a child of my own I also don't want to chance having to fight for my life. For our first child we're adopting and I know that I may have my ups and downs with the lupus but I'll be stronger by not putting my kidneys under further bodily stress from a pregnancy. Good luck with what you decide :lol:
Well, i am currently pg, 7 months/28 weeks. It has been great so far. I had forgotten what it felt like to wake up in the morning and not be aching or tired all day. I get tired now, but it's a different tired from the one with lupus. My husband and I found out 4 weeks into my pregnancy. It was a blessing to begin with. Since I was 16 I was told it would be difficult for me to conceive b/c of my polycystic ovaries. Then, at 18 I was diagnosed with idiopathic thrombocytopenia purpura (ITP), which after a splenectocmy and a couple of years became APS - antiphospholipid syndrome, which like saysusie mentioned is common with Lupus, but more so in women who have miscarried more than once. I have not. So, since the beginning I've been on Lovenox injections daily(40mg/0.4ml). It was so hard in the beginning - giving myself shots. I also went off plaquenil, stayed on 10 mg.s of Prednisone and added 81 mg.s of Aspirin and was able to continue Aciphex 20mg/day for my hiatal hernia. My last appt. w/my OB was last Friday and that was a bit scary b/c for the first time they found +1 protein in my urine; my BP was 140/78, and I had an 11 pound wt. gain in 3 weeks. However, my weight is still w/in 'normal' range, but they were concerned b/c my feet and ankles have been swelling as well. I have felt fine though and haven't sensed a flare up. I haven't had headaches or swelling of the face and hands or fevers. I don't want to deliver early, which slightly concerns me now, but I feel at ease knowing that my baby will have a strong fighting chance if that were to happen. This baby has to stay - I've already been to 3 family funerals this year (grandmother, aunt and a 10 year olds'). This baby was a blessing to begin with. My doctors were shocked that I wasn't spotting and haven't. My platelets have been in the 130,000's+. If all goes well, I do not expect to breast feed. We feel it would be best to resume Plaquenil especially since my flares usually occur come winter. I'm due in October. I still get my Lupus Now magazine and cry at the thought of having to return to those symptoms after pregnancy. You know, I didn't even get morning sickness. I sometimes feel guilt knowing that my little one won't know the person I was before Lupus. Well, that's my pregnancy in a nut shell.
Thanks for your response...I really love hearing everyone's stories...It gives me hope...I print out and save all of them in my little 'Lupus and Pregnancy' file that I keep....(I know I know....I'm a wierdo...lol) Keep em coming ladies!!
On this same subject... I am waiting on the blood test to come back and say if I'm prego or not. I have just been diagnosed with Lupus, and am a month late on my period. I don't know if this is normal. My Rhuematologist said that it can cause abnormalities in my menstrual cycle, but she was still worried that I am almost 4 weeks late. 2 urine tests came back negative, but she wanted to do the blood work to make sure. I am stressing out about that as well. :cry:
my last posting was redundant - sorry. I forgot to mention I was diagnosed w/Lupus in May of 2004. i have an appt. w/my OB this Thur. I'll keep you all posted. They are going to do another sonogram to make sure the baby's wt. and growth are normal. Keep your fingers crossed. I'll check back in then. :P
Laura07- I've missed my period PLENTLY of times during flares...It's definately possible.....Don't stress yourself out though....The actual blood test should definately say whether you are pregnant or not....Good news is once they get the flare under control those wonderful periods come right back again :) ....Let us know how that goes...
Runnette26-Yes keep us posted!! I will keep my fingers crossed for you too!! I'm sure you'll be fine....Don't forget to check back in with us!
Runnette26 You have nothing to worry about Babies born after 7 months do pretty well. I had my daughter at 7 months she weighted only 3lbs 12ozs, I had a really easy pregnancy up until a week before I had her. At that time my doctor said I had protein in my urine and high blood pressue, acute fatty liver of pregnancy, heart problems, toxcemia, preclampsia, and HELP syndrom, after all that my baby was born healthy and only had to stay in the hospital for 2 weeks when she came home she was 4lbs 5ozs, the littlest, most beautiful thing that I have ever seen. As long as your doctors are watching you closely you should have a smooth last couple of months. My advice to you is if you start feeling sick go to your doctor right away, I stayed home for a week and by the time I went in I could not even walk and had Katelyn 3 days later. I was scared and I hate to think what could of happened if I didn't go in when I did. Let us know how you appointment goes I am wishing you all the best. :D
Glad to hear your pregnancy went well....Were you on any meds for Lupus during your pregnancy? I worry sometimes about what I will do if I'm in pain during pregnancy and can't take anything. Like right now I take Darvocet occasionally....But I would go without for my baby of course....I worry about the toxemia/preeclampsia too....I mean my blood pressure has always been low/normal, but from what I hear that doesn't even matter in pregnancy...You can have a history of great blood pressure and STILL get pre eclampsia....So that's definately another concern of mine...But I guess we will just have to see...Thanks for your input!