Previously, we have discussed the skin conditions associated with SLE in this article. Today, let’s look at how SLE affects pregnancy.
What’s SLE?
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect various parts of the body, ranging from skin to the important organs such as kidneys. It is a long-term illness that affects primarily women in their reproductive years and can be very debilitating or even life-threatening.
Common signs and symptoms of systemic lupus erythematosus. Image via Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain
Examples of organ damage that is associated with SLE and may affect pregnancy are the kidney (which result in a related condition called lupus nephritis), heart and lung inflammation, and thromboembolic disease (i.e. formation of thrombi that blocks the blood circulation).
To further complicate matters, SLE can be difficult to diagnose. Patients with SLE can have wildly different signs and symptoms, and some of them may carry telltale signs that are difficult to differentiate from other medical conditions such as infectious disease or other autoimmune disease.
Image credit to DermNetNZ.org via CC BY-NC-ND 3.0 NZ
Image credit to DermNetNZ.org via CC BY-NC-ND 3.0 NZ
SLE and pregnancy
As SLE disproportionately affects women in childbearing age, a professional counselling before getting pregnant is crucial. The good news is: many women with controlled SLE or in remission can have a safe pregnancy and deliver a healthy baby.
Adverse effects on mother and baby
If you have SLE and would like to get pregnant, it is crucial for you to consult an obstetrician (doctor who specialises in pregnancy and childbirth) first before you attempt to conceive. This is because pregnant women with active SLE are at higher risks for premature birth and miscarriages. Women with SLE are also at a higher risk for preeclampsia, a pregnancy complication that is caused by abnormally high blood pressure after 20 weeks of pregnancy and it can damage organs of the mother with SLE, as well as limiting the growth of the baby.
Photo by Jan Canty on Unsplash
This is also in accordance with the European League Against Rheumatism (EULAR)’s recommendation: women with active or flaring SLE, especially active nephritis, history of lupus nephritis and presence of aPL (antiphospholipid antibodies), are at high risk for adverse maternal and fetal outcomes. Therefore, women with active SLE should be advised to defer pregnancy until the disease is well controlled for at least six months. In the meantime, women with SLE should be counselled about the use of effective contraceptive measures.
Reassess treatment for SLE
Medications used in the treatment of SLE must be reviewed prior to conception. Although some medications used to treat SLE are potentially harmful or contraindicated (i.e. strictly no-no) during pregnancy, many are safe. Medications that are safe to be used among pregnant individuals with SLE are:
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Low-dose aspirin (between 60 to 150mg per day) - to reduce the risk of preeclampsia in the mother and its damage on the baby.
On the other hand, SLE medications that are contraindicated and should not be used in pregnancy are:
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Cyclophosphamide
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Mycophenolate mofetil
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Methotrexate
If you’re on these treatments and would like to get pregnant, your doctor may substitute them with other medications, such as nonsteroidal antiinflammatory drugs (NSAIDs), steroids, tacrolimus, azathioprine and cyclosporine. These medications are reasonably safe but still carry a small harmful risk for pregnancy, hence they should be used with caution.
Contraception for women with SLE
As mentioned, women with SLE should be counselled about the use of effective contraceptive measures. Thanks to modern medicine, there are various types of contraception available today — each with different effectiveness, application method and costs.
Image credit: Trussell J, Aiken ARA, Micks E, Guthrie KA. Efficacy, safety, and personal considerations. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018.
The Ministry of Women, Family and Community Development reported that taking contraception pills is the most common family planning practice among married women in Malaysia, followed by tubal ligation/occlusion and condoms. You can find out more information about individual contraception methods here.
To identify the most suitable contraception method for you, consult your healthcare provider. Your healthcare provider would evaluate the most suitable contraceptive method for you based on several important factors, such as your age, body weight, health condition, personal preference, and your lifestyle factors (such as whether you smoke or not). You can read more about contraception in our article here.
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References
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UpToDate - Clinical manifestations and diagnosis of systemic lupus erythematosus in adults
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UpToDate - Pregnancy in women with systemic lupus erythematosus
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UpToDate - Approach to contraception in women with systemic lupus erythematosus
Cover image credit: Photo by John Looy on Unsplash
