Pregnancy & lupus: Updates from the 2015 American College of Rheumatology Annual Meeting

Lupus Foundation of America

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Pregnancy can be an exciting, sometimes nerve-inducing time for anyone. For women living with lupus, pregnancy can bring an additional set of concerns. For many, these concerns begin long before the news of a growing family. At this year’s American College of Rheumatology Annual Meeting (ACR) we attended many sessions about the latest research in lupus and pregnancy.  The research presented brings the promise of better outcomes for pregnant women with lupus and their babies.

This year’s conference was the first time with a session dedicated to lupus and reproductive health. In fact, the plenary session highlighted pregnancy in lupus and was attended by thousands of participants. One study in particular struck me as representative for where we stand in this area of pregnancy research in lupus. We are on the brink of new discoveries that will translate into healthier and less risky pregnancies.

For women with lupus, pregnancies are considered high risk. Compared to women without lupus, pregnant women with lupus have a higher risk of miscarriage, preterm birth (birth before 37 weeks of pregnancy), low birthweight, preeclampsia (a serious pregnancy complication that involves high blood pressure and protein in the urine). We also know that women with antiphospholipid antibodies (APL-antibodies that interfere with the normal function of blood vessels and can cause complications) have a higher risk for worse pregnancy outcomes. This new study looked at how we can more accurately identify those women who might have worse outcomes. The research focused on a part of the immune system called complement. Complement is made up of several proteins that help antibodies do their job.  The researchers found that in women with APL, activation of a specific complement pathway was strongly associated with negative pregnancy outcomes. The researchers were able to find the activated pathway as early as 12 weeks. This means that some pregnancy complications can be predicted early on. This will allow clinicians to closely monitor those pregnancies and be better prepared for those potential complications. This research also opens up the way for potential new treatments that can block that complement pathway and prevent negative pregnancy outcomes.

While it does take time for research to translate into new treatments, tests and different methods of managing care, there are many things you can do to have a healthy pregnancy.  Here is a short list for before, during and after your pregnancy.

Before you become pregnant:

  • A healthy pregnancy for women with lupus starts well before a positive pregnancy test. Have regular conversations with your rheumatologist about family planning. Talk about when you want to become pregnant, how that might affect your treatment plan and how to effectively prevent pregnancy while you wait for the right timing.

During your pregnancy:

  • During your pregnancy, staying healthy also means making sure you keep up with visits to your rheumatologist and keeping up with your treatment plan just as it was prescribed. Make sure your rheumatologist is keeping your high-risk obstetrician up to date after each appointment.
  • Throughout your pregnancy keep active when you can, eat plenty of vegetables and fruit and get plenty of rest.
  • Infections are particularly serious for people with lupus. If you’re pregnant during the flu season get your flu shot and make sure you also get the recommended TDAP shot between 27 and 36 weeks of pregnancy.

After pregnancy:

  • recent study showed that disease activity in lupus decreases during pregnancy and then increases that first year after giving birth. Between the midnight feedings and round-the-clock diaper changes (I’ve been there too!) it’s hard to find time. Make sure to ask for help so you can stick to your treatment plan and keep appointments with your care team.