Healthy deliveries prove pregnancies with lupus can be safe

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For many lupus patients, starting a family seemed like a fairy tale. But one doctor is doing something to increase the chances of delivering a healthy baby.

It’s estimated 1.5 million people in the U.S. suffer from lupus, an autoimmune disease. Lupus strikes mostly women of childbearing age, putting them at a higher risk of miscarriage and premature delivery.

But now, one doctor says patients can have a healthy pregnancy.

Sometimes, Emily Greenwell can’t believe she gave birth to a beautiful baby boy named Finley.

“Nine pounds and he was 22 and a quarter inches long,” Emily said of Finley at his birth.

Emily has lupus, a chronic autoimmune disease that can damage the skin, joints and organs. It can also cause inflammation.

“We’ll see kidney inflammation, which can cause kidney failure in some situations,” Dr. Megan Clowse said.

That’s why Clowse, a Duke University rheumatologist, says that for years women with lupus were warned not to get pregnant because they would have to stop the medications that controlled the disease.

“I think now we have come to sort of a new approach to lupus pregnancy management,” Clowse said.

Clowse says keeping lupus well controlled during pregnancy is key.

“My approach here at Duke, I continue almost everybody on hydroxychloroquine,” she said.

Also known by its brand name, Plaquenil, Clowse says the drug has been shown to be safe during pregnancy.

“I have managed about 150 lupus pregnancies over the past decade," Clowse said. "We have probably about 30 percent of our pregnancies deliver early.”

She says those premature births tended to occur in women who got pregnant while their lupus was active.

“So, in my experience, plan the lupus pregnancies,” Clowse recommended.

Emily was carefully monitored by her doctor the entire pregnancy.

Now the proud parents of a healthy baby boy, Emily and her husband, Moxie, say despite the lack of sleep, it’s all worth it.

“Every day is a different day, and it’s been amazing,” Emily said.

Emily says she never had a flare-up during her pregnancy and felt great.

Clowse says if you have lupus and get pregnant unexpectedly, call your doctor’s office right away and tell them the medications you are taking, because some may cause birth defects and should be stopped immediately. For more information please visit lupuspregnancy.org.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: PREGNANT WITH LUPUS CAN BE SAFE: JUST ASK FINLEY
REPORT: MB #4505

BACKGROUND: Lupus is a chronic autoimmune disease that can damage any part of the body. Because lupus can affect so many different organs, a wide range of signs and symptoms can occur. These symptoms may come and go, and different symptoms may appear at different times during the course of the disease. Some common symptoms are extreme fatigue, headaches, painful or swollen joints, fever, anemia, butterfly-shaped rash across cheeks and nose, hair loss, and mouth or nose ulcers. Lupus is sometimes called "the great imitator" because its symptoms are often like the symptoms of rheumatoid arthritis, blood disorders, fibromyalgia, diabetes, thyroid problems, Lyme disease, and a number of heart, lung, muscle, and bone diseases.
(Source: https://www.lupus.org/resources/common-symptoms-of-lupus)

PREGNANCY: Lupus does not reduce a woman’s chances of getting pregnant. Less than 50 percent of pregnancies in women with lupus have complications, but all lupus pregnancies are considered high-risk. Lupus can complicate pregnancy with an increased risk of miscarriage, premature delivery, and preeclampsia, as well as heart problems in the baby. Kidney or liver damage caused by lupus increases the chance of complications during pregnancy. Pregnancy tends to increase stress on the damaged organs.
(Source: https://www.webmd.com/lupus/features/lupus-pregnancy-pregnant#1)

MEDICATIONS: Megan Clowse, MD, Associate Professor of Medicine, Division of Rheumatology & Immunology at Duke University says, “Fortunately we have some medications that can be pretty effective, but we don’t really have enough medications to fix everything. Hydroxychloroquine is the medicine that we use the most. It’s also called plaquenil. It’s a medicine that’s been around for decades.” Dr. Clowse has managed 150 lupus pregnancies over the past decade. For women who are pregnant with lupus, she says, “Know that hydroxychloroquine can be continued. Azathioprine can be continued. Prednisone can be continued and should probably be continued. If you’re talking one of the few medications that we know cause birth defects then you need to stop those right away and get in to see your doctor soon to see if they need to switch your medicines around. The medicines I recommend stopping are Methotrexate; that should be stopped right away. Also mycophenolate and cyclophosphamide or Cytoxan.”
(Source: Megan Clowse, MD)