There is no reason to resign or lose hope: just follow a proper path as long as you are looking for a baby.
Planning for conception and having a team of specialists follow you before, during and after the nine months: these are the two fundamental moves that make it possible for a woman with systemic lupus erythematosus, or other rheumatic diseases, to complete her pregnancy and have healthy children. “Often demoralized women arrive at our clinic, perhaps because they have read incorrect information on the Internet,” observes Maria Gerosa, Head of the “Pregnancy Clinic” of the ASST Gaetano Pini – CTO of Milan and researcher at the University of Milan. “But these data are old, when the disease was less known. Now it’s not like that anymore: a woman with this disease can easily fulfill her dream of having a child. In fact, even more than one, if she so desires”.
What is the path that the woman should take?
In Italy, the incidence of lupus is between 3 and 5 new cases per year per 100,000 inhabitants. The disease affects women in a clear prevalence and the peak is between 15 and 45 years, so in full fertile age. “In our clinic, we first evaluate the ‘history’ of each woman and her type of disease,” explains Dr. Gerosa. “Lupus erythematosus is a very heterogeneous disease: its manifestations can vary greatly from patient to patient. There are lighter and more serious forms of lupus erythematosus, although today, thanks to the drugs and the fact that the disease is diagnosed earlier and earlier, the risk of it causing irreversible damage is much lower than in the past. The most affected areas, in general, are the skin, mucous membranes, kidneys and joints (although all apparatuses can be involved). “Secondly, the therapy is examined: it is assessed whether it is appropriate that the drugs that the woman is taking are suspended before conception and replaced with more appropriate ones or can be continued. Once the pregnancy has begun, our centre remains available for any possible modification or modulation of the therapy”.
Are there any particular problems related to pregnancy?
“During the waiting period, the disease can sometimes become more acute. The risk is about 20%, but if the pregnancy is well planned these are usually mild symptoms, which can be well controlled with drugs allowed even during the nine months,” explains the expert. “Lupus erythematosus, then, can expose to a greater risk of developing complications typical of pregnancy: for example, gestosis, an alteration in the function of the placenta and therefore a poor development of the fetus or premature birth. Today, however, we know that these problems are greatly reduced if the pregnancy is planned at a time when the disease is in remission phase – ie is in excellent control and well managed by drugs – for at least six months.
Can lupus erythematosus cause difficulties for conception?
“This disease has no negative effect on fertility,” reassures the specialist. “It is true, however, that the average age of women with lupus expecting a child is a bit higher than the average. This happens because it is recommended to plan carefully the pregnancy and, therefore, is often postponed until the most favorable time is reached. And what about the drugs taken to control the disease? “There are, in fact, treatments that can give some problems from this point of view, for example those based on cyclophosphamide, a drug used in the most aggressive forms, which can reduce fertility a bit,” says the expert. “In recent years, however, it has been seen that the risk of this infertility induced can be greatly reduced by using before therapy some drugs that can put the ovary to rest”.
Will childbirth be natural?
“Yes, indeed, it is advisable that it be,” says the expert. “C-section is still a surgical operation that involves stress for the body. Moreover, since the disease slightly increases the risk of thrombosis, it is better to avoid that the woman is forced to rest in bed, even if for a few days. Finally, the new mother, if she wishes, can breastfeed. “Many drugs can also be taken without problems during breastfeeding,” confirms Dr. Gerosa.