As an obstetrician I am asked on a daily basis by my Lupus patients if it is safe for them to become pregnant. The majority of the times, my response is “yes”. However I emphasize the need to prepare well before attempting to become pregnant….
Obstetrics is a team sport and pregnant Lupus patients are best cared for by a team of physicians. The team usually includes a Rheumatologist or internist familiar with pregnant Lupus patients, an Obstetrician, who coordinates care throughout the pregnancy and delivers the baby, and lastly a Maternal Fetal Medicine specialist who will closely monitor the fetus and mother during this high risk pregnancy.
Disease stability is the key. Medications need to be reviewed with your team of physicians to be sure that there will not be any untoward effects for you or the developing fetus. For example if you are already taking Plaquenil, Imuran , or Prednisone and your disease is stable then remaining on these medications is the best course. However, if your disease is not stable, then it would be best to adjust these approved medications. Some medications are not approved for pregnancy and it would be best to taper off medications that could present harm to the developing fetus before attempting pregnancy. Lupus patients that are stable several months prior to becoming pregnant have the best outcomes.
Physical activity is important for Lupus patients in general and for pregnant Lupus patients especially. Many Lupus patients already have body aches and pains in their muscles and joints. The hormones of pregnancy cause the ligaments and joints to relax and with the extra weight from the pregnancy distributed all in front by the pregnant uterus, patients can experience; back, hip, and knee pain.
Aerobic exercises such as; walking, running; swimming and bicycling are safe in pregnancy. However, stability is most important. Adding stretching and strengthening exercises to your routine with Pilates and Yoga, will lessen pain and even help in labor.
In conclusion, work with your rheumatologist and other team members to optimize your medications and stabilize your disease. Start your prenatal vitamins; refine your diet and workout routine, so that you can achieve the best outcome for you and your baby.
By Paul Hackmeyer, MD