Lupus In Pregnancy - What Should I Know?

Continuing the lupus thread duing Lupus Awareness Month, let's look at lupus during pregnancy. First, you should know that having lupus does not preclude a successful pregnancy outcome. There are risks involved, however, for both mom and baby. The March of Dimes ists the following:

What problems can lupus cause during your pregnancy?

Lupus may increase the risk of these problems during pregnancy:

Lupus flares. You may experience flares during pregnancy or in the first few months after giving birth. If your lupus is in remission or under good control, you’re less likely to have flares.

Preeclampsia. This is a certain kind of high blood pressure that only pregnant women can get.

Premature birth. This is birth that happens too early, before 37 weeks of pregnancy.

Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.

Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.

If you’ve been in remission or had your condition under good control for at least 6 months before pregnancy, you’re less likely to have complications. Talk with your health care provider before getting pregnant about the safest time for pregnancy.

What problems can lupus cause in your baby?

Most babies of mothers with lupus are healthy. However, some babies may face health risks, like:

Premature birth. About 3 in 10 babies (30 percent) of mothers with lupus are born prematurely. Premature babies may need to stay in the hospital longer or have more health problems than babies born full term (39 to 41 weeks of pregnancy).

Neonatal lupus. About 3 in 100 babies (3 percent) are born with this temporary form of lupus. This condition causes a rash and blood problems but usually clear up by 6 months of age. However, up to half of these babies have a heart problem called heart block. This is a condition that causes a slow heartbeat. Heart block is often permanent. Some babies need a pacemaker to help make their heart beat regularly.

As you would expect, pregnancy for a lupus patient is hardly a walk in the park. However, there is ample evidence that remission in disease activity optimizes a woman's chances for a successful outcome.

During pregnancy, expect to see two consultants on a regular basis - the Maternal Fetal Subspecialist and your Rheumatologist. Expect to have many tests and frequent visits. Do keep your appointments to give yourself and your baby the best possible odds. And above all else, hang in there. You can emerge with a healthy, happy baby.

For more information or to schedule an appointment for an ultrasound, call: (718-925-6277)

Miscarriage - Can It Be Lupus?

May is Lupus Awareness Month. Lupus is an autoimmune disease in which the immune system attacks the body's own tissues, causing inflammation, swelling, pain, and damage. Lupus symptoms include fatigue, joint pain, fever, and a lupus rash. But sometimes, adverse pregnancy outcomes such as repeated miscarriage are the first sign of this disease.

Although an uncommon cause, risk of miscarriage is higher in patients with an autoimmune disease such as lupus.

If you've had two or more miscarriages and are unsure, you should ask about a diagnostic investigation. Your health as well as a successful pregnancy outcome may depend on it.

For more information, or to schedule an ultrasound, please call: (718) 925-6277.

Maternal Weight And Stillbirth

This past week in the Journal of the American Medical Association, a statistical analysis of 38 studies of moms' weight either prior to pregnancy or in early pregnancy showed a relationship between maternal BMI and risk of stillbirth. The loss of a wanted pregnancy at any gestational age is tragic but the worst has to be a fetal death in the few weeks prior to birth. The nursery has been set up. The birth announcements prepared. Often, the room is packed with gifts from the baby shower. All this adds to the immense suffering of the loss of a child.

So how is maternal weight linked to stillbirth? The authors suggest the possibility that the increased amount of adipose tissue may exert metabolic effects which affect placental function. We already know the effect of weight, fat, and type 2 diabetes, for example. A similar altered biology may be at work here as well. Another possibility is that heavier women become less sensitive to fetal movement and are thus less apt to pick up on the signals of decreasing fetal movement. The lack of this alarm mechanism may miss that narrow window for life-saving intervention.

So what should a woman considering having a baby do in light of this information? The best, obviously, is to get as close to ideal body weight as possible prior to conception. When this is not possible, early prenatal care would be essential, with a special emphasis to nutritional counseling. As pregnancy enters the "home stretch," certain tests of fetal well-being can be considered - monitoring or non-stress tests, serial ultrasounds for fetal growth, and biophysical profiles. Additionally, fetal kick counts can be done at home which require no sophisticated equipment.

Moms to be should voice any concerns with their Obstetricians. For more information, or to schedule an appointment for an ultrasound, you can call my office at: (718) 925 - 6277.