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Lupus & Pregnancy

What is lupus?

When it is working normally, the body’s immune system kills germs and “bad” cells that could turn into cancer. Sometimes, instead of killing only bad cells, something goes wrong and the immune system starts to attack healthy cells. That is called an autoimmune response. It is what happens in lupus. In other words, if you have lupus, your body is attacking itself.

Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

No two cases of lupus are exactly alike. Signs and symptoms may come on suddenly or develop slowly, may be mild or severe.

Other symptoms include Fatigue, joint pain, skin rash fever, hair loss, mouth ulcers, low blood amongst others. It is more common in women especially of child bearing age.

It can also present as unexplained strokes or blood clots

Recurrent pregnancy loss is also a symptom

The lupus picture in Kenya is mainly in ladies, joint pain and skin rash are the most common symptom

 

When to see a doctor

See your doctor if you develop an unexplained rash, ongoing fever, persistent aching or fatigue.

Ref:

  1. Uptodate: Patient education: Lupus (The Basics)
  2. Genga EK, Otieno FO, Oyoo GO. Clinical profiles of patients SLE in Nairobi Africa Journal of Rheumatology 2015; 3(2):62-66

Quick notes on lupus and pregnancy

Lupus patients are more likely to develop pregnancy complications compared to the general population.

1.What are the complications?

Pregnancy loss (or miscarriages) may occur in approximately one-fifth of lupus pregnancies.

HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets)

Hypertension, renal insufficiency,

Urinary tract infections

Diabetes

2.Can lupus affect my baby?

Mothers with anti-Ro/SSA or anti-La/SSB antibodies, the risk that the baby will have neonatal lupus erythematosus is 25%.

The anti-Ro/SSA or anti-La/SSB antibodies increases the risk for heart problems in the baby (congenital heart block). Thus, if you carry these antibodies, your obstetrician will regularly check the baby’s heartbeat starting at around your 16th week of pregnancy.

Mothers with lupus are more likely to have babies with intrauterine growth retardation (IUGR) and low birth weight.

3.When is the best time to conceive?

lupus disease activity is fully under control and you are in your best health.

Its strongly recommended to avoid pregnancy until 6 months of well controlled lupus has elapsed. Those with kidney disease are at a higher risk of pregnancy loss as pregnancy puts an extra burden on your kidneys.

After your pregnancy test is positive, you should visit your rheumatologist and obstetrician at your soonest possible convenience.

4. Can pregnancy lead to the worsening of lupus?

lupus flares can occur during pregnancy or immediately following delivery

Women who conceive at least six months after the lupus disease activity has been brought under control are less likely to experience a lupus flare than those who conceive while their lupus is active.

5. How can you identify the symptoms of lupus flare during pregnancy?

Symptoms that suggest a lupus flare during pregnancy include fatigue, body aches, fever, butterfly shaped redness across the nose and cheeks, or patchy hair loss, joint pain.

Lupus flares detected early are easier to treat and in turn cause less harm to the mother and the baby.

6. Which lupus medications can be safely used during pregnancy?

Selected medications are safe during pregnancy. The choice of medicine during pregnancy is done in consultation with your rheumatologist and obstetrician.

Examples of safe medicines include

Steroids preferably used in the lowest dose possible. Steroids do have side effects ranging from raising blood pressure, kidney problems, increasing risk of diabetes, low birth weight amongst others. The side effects can be minimized by (a) consuming a low salt diet (to prevent high blood pressure); (b) taking calcium and vitamin D (to prevent bone loss); and (c) exercising regularly (to prevent bone loss and excessive weight gain).

Drugs for Lupus- Azathioprine, Hydroxychloroquine

Blood thinners- Aspirin

Ref : Lupus Foundation of America

 

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