Medication for lupus during pregnancy

Medication for lupus during pregnancy

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Is it safe to take lupus medications while I'm pregnant?

The unfortunate reality is there's a risk in taking any medication during pregnancy. Some drugs for systemic lupus erythematosus (SLE) are considered low-risk to take in pregnancy, and some increase a baby's risk of birth defects.

That's why it's important to talk with your healthcare provider about your plans to get pregnant at least six months before trying to conceive. Your provider can review your medication and recommend safer alternatives if necessary.

Giving yourself time to prepare means you can be sure that your condition is stable with any new medication you're taking before you become pregnant. This is important because having lupus under control is key to a healthy pregnancy.

You may wonder if you should stop taking medication altogether. But stopping medication is risky too, not just for you, but also for your baby. Without medication, lupus could flare during pregnancy, making potentially harmful complications more likely.

Managing any chronic disease during pregnancy is a balancing act, weighing the risk of one possible outcome against another. Talk to your provider about the risks and benefits of the medication you're taking, and get a second opinion if you're unsure what's right for you. This gives you the best chance of making informed choices about how to manage your condition while you're pregnant.

Which lupus medications are low-risk to take during pregnancy?

No medication is completely without risk, and some drugs should be used only if needed. Your provider can help you weigh the benefits and risks of each drug you take. The drugs below can be taken during pregnancy and are listed from most to least commonly recommended.

Active or in remission

  • Immunosuppressants. Hydroxychloroquine (Plaquenil) is recommended for all women with lupus during pregnancy. Hydroxychloroquine was originally an antimalarial medication that was found to reduce the risk of lupus flares during pregnancy as well. It isn't known to cause any problems in babies and may help prevent neonatal lupus. Neonatal lupus is a condition that affects a small number of babies born to women who have Sjögren's syndrome type A or B antibodies in their blood. Some babies exposed to these antibodies develop a potentially life-threatening complication called congenital heart block.

Active or with complications

  • Corticosteroids. Steroids are used to prevent and treat lupus flares. Prednisone is considered the safest corticosteroid to use during pregnancy because only very small amounts cross the placenta.
    If you took steroids to control lupus before you became pregnant, it's likely that your provider will suggest you continue, but she may reduce the dose. Doses higher than 10 milligrams (mg) per day increase the risk of complications such as high blood pressure, diabetes, gaining too much weight, infections, and premature rupture of membranes (when water breaks early).
    If you have a lupus flare, your provider may recommend a short course of steroids at a higher dose to bring lupus under control. If you have been on higher doses of steroids around the time of delivery, you may be given an additional dose ("stress dose") when you're in labor to help your body cope with the physical demands of giving birth.
  • Immunosuppressants. These powerful drugs prevent the immune system from attacking healthy parts of the body. Azathioprine (Imuran) is an immunosuppressant used alone or with a steroid to manage flares during pregnancy. Azathioprine is considered safer in pregnancy than other immunosuppressants, which typically have more severe side effects and a higher risk of effects on babies. Although experts consider azathioprine safe during pregnancy, some studies suggest the drug may be associated with small defects in a baby's developing heart (atrial or ventricular septal defects), and with babies being born early or at a lower birth weight.
  • Anticoagulants (blood thinners). Blood-thinning medications, called unfractionated heparin or low molecular weight heparin (Lovenox or Fragmin), are prescribed to women who have antiphospholipid antibodies in the blood or a history of blood clots. These medications don't cross the placenta, so they are considered safe to use during pregnancy. They're usually given by injection, and you may need shots twice a day.
  • Vitamin supplements. Your healthcare provider may also recommend that you take calcium and vitamin D supplements. People with lupus often lack these important nutrients for maintaining healthy bones. And getting enough calcium and vitamin D is especially important if you take steroids because one side effect of long-term steroid use is thinning bones (osteoporosis).

Which lupus medications are risky during pregnancy?

The lupus medications below are known to cause birth defects or other health problems in babies. If you're planning a pregnancy or are pregnant, your provider will review your medication and advise you on the safest treatment plan. Don't stop taking medication without talking to your provider first because that can cause problems too.

Lupus drugs that cause birth defects

These lupus medications are linked to birth defects in babies and should be stopped at least three months before trying to conceive:

  • Mycophenolate mofetil (CellCept)
  • Methotrexate (Trexall, Rheumatrex, Otrexup, Rasuvo)
  • Cyclosporine (Sandimmune, Neoral, Gengraf)
  • Cyclophosphamide (Cytoxan)

Other risky lupus drugs

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Pain-relieving NSAIDs, such as ibuprofen and naproxen, are used in the first and second trimesters only when there aren't any other alternatives. Taking NSAIDs in the first trimester has been linked to birth defects, although experts can't be sure the drugs are responsible. NSAIDs aren't recommended after 28 weeks of pregnancy because they increase the risk of a baby developing a condition that causes an important blood vessel to the lungs to close earlier than usual (premature closure of ductus arteriosus). Your provider may suggest taking acetaminophen instead of an NSAID because it's safer during pregnancy.
  • Corticosteroids. Some corticosteroids aren't safe to use routinely during pregnancy. Dexamethasone (Decadron) and betamethasone (Celestone) both treat lupus nephritis but cross the placenta in high concentrations and can affect a baby's development. However, in small doses these drugs can also help a baby's lungs develop more quickly than normal, which is important if it looks like you could deliver early.
  • Immunosuppressants. Leflunomide (Arava) is a medication that could cause serious birth defects. It can take up to two years to clear from the body, so it's not usually prescribed to women (or men) who want to have children. If you take leflunomide to control lupus, you may be given a treatment to flush it from your body before you start trying to conceive.
  • Anticoagulants (blood thinners). Warfarin is used to treat or prevent blood clots, and it can be very harmful to babies, causing birth defects or miscarriage when used in the first trimester. Warfarin can be taken with caution in the second and third trimesters. Heparin (see above) is a safer alternative, so your provider will likely switch you to it to lower the risk to your baby.

Will my treatment change during labor and birth?

It's possible your treatment for lupus will change. If you were taking high doses of steroids before you became pregnant and continued to use them during pregnancy, you may get a stress dose, as mentioned above.

If you're at risk of a preterm delivery, your provider may prescribe a steroid (either dexamethasone or betamethasone) to mature your baby's lungs and other organs as quickly as possible before birth.

You also may need medication to prevent blood clots after you've delivered. This could be either heparin or warfarin. Warfarin isn't recommended during pregnancy, but it's considered safe to take after delivery and when breastfeeding.

Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.

Watch the video: Medical Breakthroughs - Pregnancy with lupus (May 2022).

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