By: dr. Faisal Parlindungan, SpPD, K-R
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can affect various organ systems in the body. Although it does not directly cause infertility, lupus can present unique challenges for women who wish to become pregnant. One of the main challenges faced by women with lupus who want to conceive is the risk of lupus flares or disease exacerbations during pregnancy. Lupus flares can trigger various complications, such as organ damage, high blood pressure, and placental issues that can threaten the health of both the mother and the fetus. Therefore, it is crucial for women with lupus to consult with a doctor before planning a pregnancy. The doctor will evaluate the disease activity, adjust medications if necessary, and help plan the optimal time for conception.
In addition to flares, women with lupus also have a higher risk of experiencing other pregnancy complications, such as preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), miscarriage, preterm birth, fetal growth restriction, fetal death, stillbirth, low birth weight, and neonatal lupus. To minimize the risk of complications, it is important for women with lupus to optimize their health before becoming pregnant. This includes controlling lupus disease activity with regular treatment, maintaining a healthy diet, exercising regularly, managing stress, and avoiding risk factors such as smoking and alcohol consumption.
Prenatal Care
Once pregnant, women with lupus should undergo regular and more frequent prenatal check-ups compared to women without lupus. These check-ups will involve close monitoring of:
- Lupus disease activity
- Organ involvement
- Medication history
- Recent serological profile including anti-dsDNA, anti-Ro/La, APL antibodies, and complement levels
- Other medical conditions (e.g., hypertension, diabetes)
- Previous obstetric history
- Blood pressure, urinalysis
- Complete blood count, urea and creatinine, liver enzymes, and specific organ examinations
- Ultrasound screenings
- Based on the examination results, patients are classified as having either remission or stable SLE, early-stage or active SLE, and severe organ damage.
SLE Treatment During Pregnancy
Treatment of lupus during pregnancy also requires special attention. Pregnant patients with SLE are recommended to receive aspirin from 12 weeks of gestation. Some medications commonly used to treat lupus, such as methotrexate and mycophenolate mofetil, can harm the fetus and should be discontinued at least 3 months before planning pregnancy. However, other medications, such as hydroxychloroquine, are considered safe during pregnancy and can help control lupus symptoms and prevent neonatal lupus. Other drugs such as corticosteroids and immunosuppressants are administered according to the degree of disease activity.
During labor, dosage adjustments are made again. If the patient is on long-term corticosteroid use, intravenous hydrocortisone should be prepared to reduce physical stress during delivery. Patients with standard prophylaxis low molecular weight heparin (LMWH) should discontinue it during spontaneous labor or 24 hours before induction or elective cesarean section. Postpartum, monitoring of disease activity and thrombosis risk is also necessary.
It is important to remember that each woman with lupus has a unique situation, and care plans must be tailored to individual needs. Emotional support is also crucial during pregnancy. Joining support groups or talking to others with similar experiences can help women with lupus feel more confident and supported throughout their pregnancy journey. With careful planning, strict medical monitoring, and a good understanding of the risks involved, a healthy and successful pregnancy for lupus patients is still possible.
Resources
- Perhimpunan Reumatologi Indonesia. Rekomendasi IRA untuk Diagnosis dan Penatalaksanaan Lupus Eritematosus Sistemik. Divisi Reumatologi Departemen Ilmu Penyakit Dalam FKUI/RSCM; Jakarta. 2019.
- Iozza I, Cianci S, Di Natale A, Garofalo G, Giacobbe AM, Giorgio E, et al. Update on systemic lupus erythematosus pregnancy. J Prenat Med. 2010 Oct;4(4):67–73.
- Dao KH, Bermas BL. Systemic Lupus Erythematosus Management in Pregnancy. Int J Womens Health. 2022;14:199–211.
- SaucSLEcu IC, Opris-Belinski D, Balanescu AR, Pavel B, Gica N, Panaitescu AM. Preparing for Pregnancy in Women with Systemic Lupus Erythematosus-A Multidisciplinary Approach. Medicina (Kaunas). 2022 Sep 29;58(10):1371.
- Hamijoyo L, Martha JW, Hidayat S, Akbar MR, Tantono H, Sakasasmita S, et al. Risk Factors for Poor Pregnancy Outcome in Systemic Lupus Erythematosus Patients. Acta Med Indones. 2019 Apr;51(2):102–9.
