|
Twenty
years ago, medical textbooks said that women with lupus
should not get pregnant because of the risks to both the
mother and unborn child. Today, most women with lupus
can safely become pregnant. With proper medical care you
can decrease the risks associated with pregnancy and deliver
a normal, healthy baby.
To
increase the chances of a happy outcome, however, you
must carefully plan your pregnancy. Your disease should
be under control or in remission before conception takes
place. Getting pregnant when your disease is active could
result in a miscarriage, a stillbirth, or serious complications
for you. It is extremely important that your pregnancy
be monitored by an obstetrician who is experienced in
managing high-risk pregnancies and who can work closely
with your primary doctor. Delivery should be planned at
a hospital that can manage a high-risk patient and provide
the specialized care you and your baby will need. Be aware
that a vaginal birth may not be possible. Very premature
babies, babies showing signs of stress, and babies of
mothers who are very ill will probably be delivered by
cesarean section.
One
problem that can affect a pregnant woman is the development
of a lupus flare. In general, flares are not caused by
pregnancy. Flares that do develop often occur during the
first or second trimester or during the first few months
following delivery. Most flares are mild and easily treated
with small doses of corticosteroids.
Another
complication is pregnancy-induced hypertension. If you
develop this serious condition, you will experience a
sudden increase in blood pressure, protein in the urine,
or both. Pregnancy-induced hypertension is a serious condition
that requires immediate treatment, usually including delivery
of the infant.
The
most important question that pregnant lupus patients ask
is, Will my baby be okay? In most cases, the answer
is yes. Babies born to women with lupus have no greater
chance of birth defects or mental retardation than do
babies born to women without lupus. As your pregnancy
progresses, the doctor will regularly check the baby s
heartbeat and growth with sonograms. About 25% of lupus
pregnancies end in unexpected miscarriages or stillbirths.
Another 25% may result in premature birth of the infant.
Although prematurity presents a danger to the baby, most
problems can be successfully treated in a hospital that
specializes in caring for premature newborns.
About
3% of babies born to mothers with lupus will have neonatal
lupus. This lupus consists of a temporary rash and abnormal
blood counts. Neonatal lupus usually disappears by the
time the infant is 3 6 months old and does not recur.
About one-half of babies with neonatal lupus are born
with a heart condition. This condition is permanent, but
it can be treated with a pacemaker.
Planning Your Pregnancy
You
and your spouse or partner should talk to your doctor
about the possibility of pregnancy. You and the doctor
should be satisfied that your lupus condition is under
good control or in remission. Your doctor should also
review potential problems or complications that could
arise during the pregnancy, their treatment, and outcomes
for both you and the unborn child.
You
should select an obstetrician who has experience in managing
high-risk pregnancies. Additional experience in managing
women with lupus is also good. The obstetrician should
be associated with a hospital that specializes in high-risk
deliveries and has the facilities to care for newborns
with special needs. It is a good idea to meet with the
obstetrician before you become pregnant so that he or
she has an opportunity to evaluate your overall condition
before conception. This meeting also will give you the
opportunity to decide if this obstetrician is right for
you.
Check
your health insurance plan. Make sure that it covers your
health care needs and those of the baby and any problems
that may arise.
Review
your work and activities schedule. Be prepared to make
changes if you are not feeling well or need more rest.
Consider
your financial status. If you work outside the home, your
pregnancy and motherhood could affect your ability to
work.
Develop
a plan for help at home during the pregnancy and after
the baby is born. Motherhood can be overwhelming and tiring,
and even more so for a woman with lupus. Although most
women with lupus do well, some may become ill and find
it difficult to care for their child.
After the Baby Is Born (The Postpartum Period)
Be
sure your doctor or nurse reviews with you the physical
and emotional changes that occur as your body returns
to normal. These changes are the same as those experienced
by women who do not have lupus.
Be
aware that postpartum complications can arise. In addition
to those that can occur to any woman who has been pregnant,
you might develop a lupus flare.
Try
to breastfeed your baby. It is the ideal, low-cost way
to provide nutrition for your baby in the first weeks
or months of life. It takes time for mothers and babies
to learn how to breastfeed and it may take a few weeks
to get adjusted. Because breastfeeding can sometimes be
a challenge, ask your doctor or nurse for help so you
do not become discouraged. Sometimes, though, breastfeeding
may not be possible for the following reasons:
- A
premature baby may not be able to suck adequately. Feeding
your baby through a tube at first and then by bottle
may be necessary. However, you may still be able to
pump your breast milk for your baby.
- If
you are taking corticosteroids, you may not be able
to produce enough milk.
- Some
medications can pass through your breast milk to your
infant. It will be up to your doctor to decide if breastfeeding
is safe if you are taking any of these medications.
- Because
breastfed infants tend to eat more frequently than do
bottle-fed infants, breastfeeding can be very tiring.
You may want to switch to a bottle and formula if breastfeeding
becomes too tiring.
Be
confident, though, that whichever method you choose to
use to feed your baby, it will be the right decision for
everyone concerned.
Before
you leave the hospital, discuss birth control options
with your doctor. Because it would be unwise for you to
become pregnant again soon after giving birth, be sure
to use an effective birth control method. REMEMBER: You
can get pregnant before your period begins again; also,
breastfeeding and withdrawal of the penis before ejaculation
are not effective birth control methods.
|
.gif)
