Lupus And Women
Lupus is often characterized as a woman’s disease. The reason it is lumped in this category is that over 75 percent people with autoimmune diseases are women and 9 out of 10 people with Lupus are women. Since the hormone estrogen is thought to play a role in Lupus, it is logical that more women are diagnosed between the ages of 15 and 45. It is also why, in lupus patients who are diagnosed as children or in elderly years we see the diagnoses of Lupus even out more between men and women.
We also know that stress on the body may be a trigger for Lupus. One of the greatest stresses on a woman’s body is pregnancy. There is a myth that women with lupus should not have a baby, and it is simply not true for most women with the disease. A pregnancy just requires more observation by a physician. The disease itself does not cause miscarriages. There are some cases, though, of women with no lupus systems prior to pregnancy developing active Lupus after the baby is born.
During menopause, though, many women experience relief from symptoms. Again, hormones may play a role in the relief. Many post-menopausal women say that it is the best time in the course of the disease. While they may not be free from Lupus flares, there seems to be a reduction in painful symptoms.
Lupus and Pregnancy
It used to be that doctors told women with Lupus to avoid having children, and some doctors today still use that outdated information to warn women to avoid getting pregnant. However, recent studies along with improved treatments now demonstrate that most Lupus patients can safely have healthy children. There are some circumstances when pregnancy can bring about serious health risks, but they are not as prevalent as doctors once believed.
Women with Lupus are just as able to get pregnant as women without Lupus except when there is certain disease activity, the woman is on dialysis, or if she is taking specific medication. For instance, it is not unusual for Lupus patients to have irregular periods, which can make planning a pregnancy difficult.
Also, 30 percent of patients have kidney disease and between 10 to 20 percent of those patients require dialysis. With dialysis there is an interruption in regular menstrual cycles and also increase in health risks for the mother and baby. Drugs that interfere with ovulation include cyclophosphamide, which can cause premature menopause.
There are some circumstances in which treatments in males can affect fertility. For instance, sperm counts in men undergoing chemotherapy are decreased, which can make getting pregnant difficult for a couple. Some men store their sperm prior to chemotherapy treatment and opt for in-vitro fertilization.
In most cases, pregnancy risk is based on the status of the woman’s Lupus. Women who are low risk usually have a mild form of the disease or are in remission. They are not taking any medication and lack the RoSSA and the anticardiolipin antibody. Also, women who have DLE or DILE are at low risk.
Risk of miscarriage or maternal organ failure usually increases with a variety of circumstances, as 3 percent of high-risk patients do die. A woman is considered high risk if she has active lupus myocarditis, active Lupus nephritis with an increased serum creatinine, or has severe or uncontrollable high blood pressure. Also, if chemotherapy is needed during pregnancy the treatment can cause fetal anomalies, malformation, or maternal infection.
Many women who are in the high-risk category still want to try for a baby. Approximately 20 percent of those women go through their pregnancy with little difficulty. Another 20 percent have serious complications, while the remaining miscarry. However, if a woman has organ threatening Lupus, the risks are often too high and adoption is usually recommended.
Since risk during pregnancy is based upon lupus activity in the body, it seems to make sense that pregnancy should coincide with a period of good disease control. Therefore, it is important that a woman with lupus get a pre-pregnancy assessment so she can have a clear idea of the risks, if there are any. It also allows the physicians to have a baseline comparison of symptoms and health, so they can quickly identify a flare during pregnancy.
During the assessment the physician will be looking at the anti-Ro and anti-La antibodies. The reason for this assessment is the anti-Ro antibody has been known to cause some heart rhythm disturbances in some babies born to mothers who carry the antibody. It may also cause neonatal Lupus, though the disorder is relatively rare.
The assessment will also take a look at what medications are absolutely necessary during the pregnancy for lupus management. Some women may wish to stop taking all her medications, but stopping all medication can actually pose a greater risk to the mother and the baby.
Each patient’s treatment differs, so it is important to work with the physician regarding which medications are safe. For instance, it is widely accepted that NSAIDs are safe for pregnant mothers up until the end of the second trimester, at which point they become harmful to the fetus. Also, some doctors feel that immunosuppressives are not safe during pregnancy.
Two drugs that should be avoided during this time are methotrexate, which causes miscarriage and fetal defects, and cyclophosphamide, which may cause birth defects.
This is why it is not a good idea to get pregnant during a flare. The body is under a great deal of stress at that time, and it increases risk. Also, medication is imperative to keeping the Lupus under control. Most doctors recommend waiting at least 6 to 7 months after a flare so that the body can recover and stabilize prior to becoming pregnant.
Many women are concerned about flares during pregnancy, and they can occur. Most often flares will occur during the first trimester and within three months after giving birth. This is due mainly to hormonal fluctuations during these times. However, most flares are mild and can be treated easily with low doses of corticosteroids.
Thank you Freedom From Lupus!
***********************************************II am a Lupus survivor…let me know if I can answer any questions for you. I have had this disease all my life. Yet was not diagnoised with it until 1995.
~The Baby Boomer Queen~