S, a 29-year-old nurse was both excited and worried when she was pregnant. Excited, because this was the first time she was on her way to motherhood. Worried, as she knew that she might encounter many potential complications during her pregnancy.
S was married for about a year. She was diagnosed as having lupus 3 years ago when she was admitted to the hospital because of fever, joint pains and “butterfly” rashes over her face. She was treated with medications by the rheumatologist. Except for a few episodes of “flares”, she was in remission for the past six months.
What is lupus?
Lupus, medically known as Systemic lupus erythematosus (SLE), is a chronic autoimmune disease in which the immune system cannot distinguish the difference between healthy cells and foreign invaders, causing it to attack its own tissues and resulting in widespread inflammation and tissue damage in the affected organs. The organs affected are usually the joints, skin, brain, lungs, kidneys, and blood vessels.
Causes of Lupus
The causes of SLE are unknown, but are believed to be linked to environmental, genetic, and hormonal factors.
Complications during pregnancy
Because of improved treatment of SLE over the past decades, more women are getting pregnant during the remission stage. However, pregnancy complications are much higher compared with healthy women.
Complications in the mother include:
Disease flares Flares (exacerbation of symptoms) of SLE can occur during pregnancy in about 10 to 30 % of cases. They are more common in younger patients and often present during the first or second trimester or during the first few months after delivery. Most flares are mild and can be easily treated with small doses of steroids.
Preeclampsia (hypertensive disease in pregnancy) Occurs in about 15 to 30 % of patients. It may occur more frequently among women with “flares” or in women with kidney disease. A daily low-dose aspirin during pregnancy may reduce the risk of preeclampsia.
Kidney impairment Kidney damage caused by SLE may cause further deterioration of kidney function.
Premature delivery There is an increased risk of premature birth and is related to the severity of the disease
Foetal loss Miscarriage and stillbirth rates are higher with SLE especially if the mother has preeclampsia, active lupus or kidney damage.
Low birth weight baby Kidney complications, high blood pressure, premature birth or "premature rupture of membranes" (when the water breaks before contractions begin) all contribute to this complication.
Complications in the new-borns:
The most serious complication of neonatal lupus is complete heart block in which the baby is born with an abnormally slow heart rate. Sometimes, the baby may have neonatal lupus with rashes on the scalp and around the eyes. The rash almost always resolves by six to eight months of age. Most of these infants do not develop SLE in later years.
S and her husband were aware of the complications. She decided to take sabbatical leave. Working together with the rheumatologist, her pregnancy was monitored closely with blood and urine tests and regular ultrasound examination. Her kidney function remained normal. At about 34 weeks of gestation, her blood pressure started to get elevated. Labour was induced at 37 weeks of gestation and she delivered a healthy girl normally.