Reproductive Health

Many people with lupus have healthy pregnancies. It is important to talk with your doctor beforehand to make a safe pregnancy plan, ideally 6 months in advance (see “Talking to your Doctor” section). This is so you can make sure your symptoms are under control and you are not at risk for a lupus flare, as flares increase the risk for pregnancy complications.

Your doctor may adjust your treatment plan, as some lupus medications are unsafe to continue taking during pregnancy.

See this website for more information regarding medication safety and pregnancy: lupuspregnancy.org/medication-list/

If you do not want to get pregnant, know that there are many safe birth control options that can help prevent pregnancy. There is a common myth that there are no safe birth control options for people with lupus, and this is not true. Your doctor may also recommend contraception use if you are taking medications prescribed to treat lupus that can cause severe birth defects.

Implants, intrauterine devices (IUDs) and tubal ligation have the highest effectiveness and are generally safe for people with lupus. It is important to know that these options all involve procedures.

Birth control options that contain estrogen may be avoided in people with lupus, as they can increase risk of blood clots. These hormonal options include the pill with estrogen, the patch, and the ring. If you have low blood clot risk and low lupus activity, these options may still be viable for you. Otherwise, the pill without estrogen (“mini pill”) is a safer option, though it tends to be less effective unless taken at the exact same time every day.

Condoms, sponges, diaphragms, cervical caps, spermicide, fertility awareness, and withdrawal are the least effective birth control methods.

It is recommended that you talk with your doctor about options that make sense for you and your lupus symptoms.

There are a number of things you and your medical team should do to support your pregnancy.

1. Make a plan to control your lupus activity as much as possible and prepare for a safe pregnancy. This will help reduce the likelihood of pregnancy complications.

2. Do a blood test to see if you have antiphospholipid antibodies. Some people with lupus have antiphospholipid antibodies in their blood. These antibodies may increase risk of blood clots, preeclampsia and miscarriage. If you do, you may be prescribed medication to help reduce serious pregnancy complications that these antibodies could cause.

3. Do a blood test to screen you for antibodies to SSA and SSB. This will help to understand your risk for a rare complication called Fetal Heart Block. There are medicines your doctor may recommend to lower this risk if these antibodies are found early.

4. Keep a close eye on your blood pressure and urine protein level. High blood pressure while pregnant has the potential to lead to a set of serious conditions called preeclampsia and HELLP syndrome. Both of these conditions cause severe kidney and liver damage, blood clotting, and seizures. Early treatment of high blood pressure is essential. Seek immediate emergency care if you experience any of the following symptoms while pregnant:

   • Blurry vision or vision changes

   • Debilitating headache

   • Severe stomach pain, especially under your ribs on the right side

   • Trouble breathing

Your doctor may recommend taking baby aspirin or hydroxychloroquine (Plaquenil) to help promote a healthy pregnancy and prevent complications.

Some of the recommendations below involve physical activity or exercise. However, in cases of high risk pregnancy, these activities may need to be avoided. Before you start any routine, we recommend speaking to your physician.

• Acupressure
• Communication
• Goal Setting
• Managing Emotions
• Nutrition
• Physical Activity
• Sleep
• Spirituality
• Tai Chi
• Yoga