Systemic lupus during pregnancy

What is systemic lupus?

Lupus - or systemic lupus erythematosus (SLE) to give it its formal name - is an autoimmune disease that affects one in 2,000 women (but as many as one in 500 women of Afro-Caribbean origin) and which causes chronic inflammation in the skin, joints, blood and kidneys, as well as other parts of the body. It tends to fluctuate in severity, flaring up when the body is challenged by certain triggers.

It's up to 15 times more common in women than in men, and is especially common during child-bearing years, and can affect pregnancy. Although half the pregnancies in women who have lupus are completely normal, one in four results in a premature birth. In the remaining one in four, the baby is lost through miscarriage or stillbirth.

The effect of lupus on pregnancy

If you have lupus it may affect your unborn baby in a variety of ways. For example, if it affects your kidneys there's an increased risk the baby will be stillborn.

You may develop symptoms very similar to pre-eclampsia (protein in the urine, swelling or oedema, raised blood pressure, and so on) and the baby's growth may be slow.

Other problems include premature birth, a transient rash on the baby's head and, in rare cases, damage to the baby's electrical conduction system in the heart, causing abnormal heart rhythms.

Women with SLE who are considering having a family should aim to get their lupus under control as far as possible before getting pregnant as this will reduce the risks.

The effect of pregnancy on lupus

Not only does lupus affect pregnancy but pregnancy can aggravate the lupus. It often gets worse during pregnancy or the early weeks afterwards, although rarely severely so.

In up to 15 per cent of cases, lupus actually improves in pregnancy.

Causes and risk factors

The cause isn't known, but it’s generally thought to be the result of environmental factors that act on an individual who is particularly predisposed because of their genetic make-up, causing the body's immune system to react against the tissues. These environmental factors include:

• Infection
• Drug treatments (including some antibiotics)
• Ultraviolet light
• stress

There may be a multitude of symptoms (the disease can vary enormously between individuals), and laboratory tests may show a vast array of autoantibodies, which are antibodies that are targeted against the person’s own cells.

Treatment and recovery

Specialist care is required, ideally from a rheumatologist or other consultant with experience of SLE in pregnancy, to make the risk to mother and baby as low as possible. This may involve drug treatment. You might have to travel to find such expert care as specialist services are not widespread. St Thomas' Hospital in London runs one of the few , but others have more recently been set up.