If you want to breastfeed, talk to your doctors. They can tell you which medicines you can take and which ones to avoid. Most of the medicines that are unsafe during pregnancy are also unsafe while breastfeeding. Some women need to stop breastfeeding if they need these medicines to control their RA.
Lupus and pregnancy
It is possible for women with lupus to have normal pregnancies. But women who have lupus are more likely to have problems during pregnancy than women who don’t.
If you have lupus, work closely with your doctors before and during pregnancy to reduce the chance of problems. You should not try to get pregnant until your lupus has been under control for at least 6 months.
It is very important to talk to your doctors before trying to get pregnant. You will need to see an obstetrician (a doctor who takes care of pregnant women), your rheumatologist (the doctor who handles your lupus), and your primary care doctor.
Your doctors can make sure that any medicines you take are safe to use during pregnancy. They will also do some tests to make sure your lupus is under control and that you don’t have any problems that might affect you or the baby during pregnancy.
Some lupus medicines are very dangerous for a baby, and can cause serious problems. You will need work with your doctor to stop taking these before getting pregnant:
Mycophenolate mofetil: CellCept®,– If you take this medicine, you should stop it at least 1 month before trying to get pregnant.
Cyclophosphamide: (brand name: Cytoxan®) – Stop at least 1 month before trying to get pregnant.
Methotrexate: (brand names: Rheumatrex®, Trexall™) – Stop at least 3 months before trying to get pregnant.
If you do get pregnant while taking any of these medicines, tell your doctors right away. Your doctors will help you decide whether to stop (or switch) any other medicines you are taking. Plus, they might suggest added treatment.
There are also steps that all women should take before trying to get pregnant.
Having lupus increases your risk of:
· Preeclampsia – Preeclampsia is a serious condition that affects some pregnant women. Women with preeclampsia have high blood pressure and too much protein in their urine. The condition can cause problems with the baby’s growth.
· Giving birth to a “premature” baby (the baby is born before 37 weeks of pregnancy)
· Having a baby that is smaller than normal
· The fetus dying after 10 weeks of pregnancy (a “fetus” is what a baby is called before it is born)
Having lupus can increase your baby’s risk of:
· Having a disease called “neonatal lupus” – This can sometimes happen when the mother has a certain type of antibodies (proteins in the blood). Not everyone with lupus has these antibodies. Your doctor can test your blood for them. Neonatal lupus can cause the baby to have heart problems.
· Having learning disabilities
You can reduce the risk of problems by seeing your doctors often and letting them know if you think anything is wrong. Your doctors will do tests throughout your pregnancy to check for any problems.
Some lupus medicines can hurt an unborn baby.
Other medicines are safe to take during pregnancy if needed, but only at certain times or in certain amounts: NSAIDs, Steroids – These medicines, are fairly safe in low doses during pregnancy. (These steroids are not the same steroids that athletes take to build muscle.)
There are other safe medicines available, too. Your doctors can help you decide how best to treat your lupus symptoms without hurting your baby.
Talk to your doctors about all the medicines you take and follow their directions carefully. Do not start taking any new medicines, supplements, or herbal drugs without first talking to your doctors.
Some women with lupus notice that their symptoms get worse during pregnancy. But it is not clear whether pregnancy actually causes symptoms to get worse. If your symptoms are not under control when you get pregnant, they will be more likely to get worse during your pregnancy.
Some normal pregnancy symptoms are similar to lupus symptoms. These include:
· Feeling tired
· Swelling of the hands, feet, or ankles
· Joint pain
· Trouble breathing
· Numbness or pain in the hands
· Darkening of the skin on the face
Some women with lupus notice that their symptoms get worse after they give birth. This is more likely in women who had symptoms when they got pregnant than in women whose symptoms were under control.
Women with lupus can breastfeed. But they have to avoid certain medicines to breastfeed safely. That’s because some lupus medicines can get into breast milk and harm a baby.
If you want to breastfeed, talk to your doctors. They can tell you which medicines you can take and which ones to avoid. Most of the medicines that aren’t safe to take during pregnancy also aren’t safe during breastfeeding. If you need these medicines to control your lupus, you might need to stop breastfeeding.
How to plan and prepare for a healthy pregnancy
It's very important that you see your doctor or nurse for a “pre-pregnancy check-up.” Your doctor or nurse will ask you about things that could affect your pregnancy. There are several things that you and your doctor or nurse can do to make sure that your pregnancy is as healthy as possible. These things should be done BEFORE you try to get pregnant:
Ask if the medicines you take are safe — If you take any medicines, supplements, or herbal drugs, ask your doctor if it is safe to keep taking them while you are pregnant or trying to get pregnant. Some medicines take a long time to leave your body completely, so it's important to plan ahead. In some cases, your doctor and nurse will want you to switch to different medicines that are safer for the baby. Your doctor and nurse may need to slowly get you off some medicines because it could harm you to stop them all of a sudden. This is especially important for women who take medicines to treat seizures, high blood pressure, lupus, and rheumatoid arthritis.
Check if you need any vaccines — Women who want to get pregnant should be up-to-date on their vaccines. This includes vaccines against measles, mumps, rubella, tetanus, diphtheria, polio, chickenpox (also called varicella), and possibly hepatitis. Many women got these vaccines as children. Still, it is important to check that you have had all the right vaccines. Otherwise, you could get sick with the diseases the vaccines protect against, and that could cause problems for you or your baby.
Some vaccines cannot be given during pregnancy or in the month before pregnancy. It's important to get these vaccines more than a month before you start trying to get pregnant.
Start taking a multivitamin — If you want to get pregnant, take a “prenatal” multivitamin every day that has at least 400 micrograms of folic acid. This helps prevent some birth defects. Start taking the multivitamin at least a month before you start trying to get pregnant. It’s not enough to start taking vitamins when you find out you are pregnant. At that point, your baby has already formed many body parts that rely on folic acid and other vitamins to develop normally.
It is important not to take too much of any vitamin during pregnancy, especially vitamin A. Show your doctor or nurse the vitamins you plan to take to make sure the doses are safe for you and your baby.
Check your diet — Some foods are not safe for a woman who is pregnant or trying to get pregnant. If you are trying to get pregnant, do not eat raw or undercooked meat. Avoid eating shark, swordfish, king mackerel, or tilefish because they can have high levels of mercury. Check with your doctor or nurse about the safety of fish caught in local rivers and lakes. Limit the amount of caffeine you have by not drinking more than 1 or 2 cups of coffee, tea, or cola each day. Try to eat a balanced diet rich in fruits, vegetables, and whole grains. Wash fruits and vegetables before eating them.
Stop smoking, drinking alcohol, or taking illegal drugs — If you smoke, drink alcohol, or take illegal drugs, now more than ever it is important that you stop. Using even small amounts of these substances from time to time during pregnancy could hurt your baby.
It’s not enough to stop as soon as you find out you are pregnant. By then the baby has already begun to form and could get damaged by smoking, alcohol, or drugs. If you need help quitting, speak with your doctor or nurse. There are effective treatments that can help.
Your partner should also stop smoking and using illegal drugs. He should not drink too much alcohol.
Ask about risks — Ask your doctor what the risks to you and your baby might be if:
· You have any medical conditions — If you have a medical problem, it could cause problems for you or your baby during pregnancy. Women who have certain medical conditions should work with their doctor to get their conditions under control before they get pregnant. This includes women with diabetes, high blood pressure, asthma, thyroid conditions, seizure disorders, rheumatic conditions and other problems. If these conditions are not well controlled, they can cause problems for a mother and her baby during pregnancy.
· You or your partner has a family history of a medical condition — If you or your partner has a history of a condition that could be passed on to your baby, you might need genetic counseling. Genetic counseling can help you find out what the chances are that your baby will have the condition. It will also help you sort out what your options might be if your baby does have problems. Examples of conditions that might call for genetic counseling include cystic fibrosis and muscular dystrophy.
· You might have an infection that you catch through sex — Infections that you can catch through sex, also called “sexually transmitted diseases,” or “STDs,” can make it hard to get pregnant. They can also infect and harm an unborn baby. If you think you might have 1 of these infections, tell your doctor or nurse. He or she can test for the infection and treat it. This is especially important if there is a chance of HIV infection.
Check your home and work for harmful substances — People often have chemicals or substances in their home or work that could hurt an unborn baby. Dealing with these substances can sometimes be complicated and time consuming, so it’s important to plan ahead. For instance, people who live in homes built before 1978 often have lead paint on their walls or woodwork. Lead in chips or dust from this paint could harm a baby. Ask your doctor or nurse how to deal with this and other harmful substances you might have around you.
Work on your weight — Women who weigh too little or too much can have problems getting pregnant and problems during pregnancy. You should try to reach a healthy weight before you try to get pregnant.