Topic Overview

Lupus (systemic lupus erythematosus, or
SLE) doesn’t typically affect a woman’s ability to conceive. But if you
are having a lupus flare or are taking
corticosteroid medicines, you may have irregular
menstrual cycles, making it difficult to plan a pregnancy.

If you
plan to have a baby or are already pregnant, it is very important that you and
your doctor discuss how lupus may affect your pregnancy.

  • Most women with lupus have successful
    pregnancies. Women who become pregnant during lupus
    remission are more likely to have a successful
    pregnancy.
  • Lupus increases the risk of fetal and pregnancy
    complications, including premature birth and stillbirth. This risk is greatest
    among women who have kidney problems or antiphospholipid, anti-Ro, or anti-La
    antibodies.
  • Women are encouraged to wait until lupus is under control for at least 6 months before they try to become pregnant.
  • Some women with lupus need to
    take medicines or have regular
    fetal monitoring or
    ultrasound while they are pregnant to reduce the risk
    of complications.
  • It is not clear whether women with lupus are more likely to have flares during pregnancy.

If you have miscarried before, expect that your pregnancy
will be closely monitored. Talk to your doctor about whether you have tested
positive for antiphospholipid antibodies. If so,
anticoagulant treatment may improve your chances of
having a healthy pregnancy.

Men with lupus should talk with their doctors. Some medicines should be stopped for at least 3 months before a man tries to conceive a baby.

Can I still take my lupus medicines?

You may not
be able to stop taking lupus medicines after becoming pregnant, or you may
need to start taking medicine for a symptom flare. Some lupus medicines,
like acetaminophen and prednisone, are considered safe during pregnancy. Others
may not be.

  • Immunosuppressant medicines, which may be
    prescribed for severe lupus, can cause birth defects. Do not take
    immunosuppressants if you are pregnant or wish to become
    pregnant.
  • Corticosteroids (such as prednisone) are generally
    considered safe for use during pregnancy. But these drugs are still used at the lowest doses and for the shortest time possible.
  • Cytotoxic medicines
    such as methotrexate and cyclophosphamide are stopped during pregnancy. They should be discontinued
    several months before conception.
  • A review of studies of antimalarials such as hydroxychloroquine (Plaquenil) suggests that they are safe for use during
    pregnancy.footnote 1
  • Nonsteroidal anti-inflammatory
    drugs (NSAIDs) such as ibuprofen and aspirin should be
    avoided during pregnancy unless prescribed by a doctor.

References

Citations

  1. Ruiz-Irastorza G, et al. (2010). Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: A systematic review. Annals of the Rheumatic Diseases, 69(1): 20-28.

Credits

ByHealthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD – Internal Medicine
Anne C. Poinier, MD – Internal Medicine
Specialist Medical Reviewer Stanford M. Shoor, MD – Rheumatology
Nancy Ann Shadick, MD, MPH – Internal Medicine, Rheumatology

Current as ofOctober 10, 2017