"Twenty-five years ago, a woman with lupus probably would not have considered having kids, because she simply couldn't physically take care of them" because of crushing fatigue that often is part of the disease, says Eliza Chakravarty, a rheumatologist at the Oklahoma Medical Research Foundation. "But today, for many of these women, it's not only feasible to have kids, but desirable."
Earlier diagnosis and medications now enable women with lupus to slow down the progression of their disease and treat many of the symptoms, enabling them to "live more fully in their lives," she says. "When somebody comes to me now and says, 'I'm thinking about having a baby,' I let her know that in the majority of cases, women will have safe and healthy pregnancies. But we need to do a little bit of work before they conceive to maximize the chances of a good outcome."
The most important approach is to ensure that the drugs women are taking are okay to use during pregnancy, and, if they are not, to wean women from them and get them on safer substitutes.
There are many medications for treating lupus, and women often take a combination of them. As with all drugs, they have side effects. "Some of the medications for lupus or rheumatoid arthritis can cause birth defects, but there are many alternatives that don't," Chakravarty says.
Her approach is to switch her patients from teratogenic drugs (which cause birth defects) to safer alternatives.
"I usually try for a six-month window [before they conceive] to make sure the teratogens are out of their system and that they are doing well on the new drugs," Chakravarty says. "One of the things we have learned is that having active disease while pregnant is dangerous for the mother and also a big risk factor for pregnancy complications" such as miscarriage, premature delivery and low-birthweight babies, she says.
She also follows women closely for the first six months after they give birth to ensure their disease is stable, because hormonal changes that occur with delivery, breast-feeding and stopping breast-feeding can exacerbate lupus symptoms.
"I worry that their lupus will flare postpartum, and I don't want to see women who are trying to bond with their babies also have to deal with symptoms of the disease," she says. "I like to be aggressive in treating the disease because being a new mom is hard enough."
While Chakravarty specializes in lupus and pregnancy, she says many of these approaches also would work with other autoimmune diseases.
Nothing makes her happier than when new mothers visit her to show off their babies. Moreover, "many of them come back and want to have another," she says.
Special to The Washington Post · Marlene Cimons