Lupus in Pregnancy

May is Lupus Awareness Month! 
This episode touches on the disease itself, what you can do to hopefully improve the outcome of your pregnancy and some of this import things we as physicians watch out for in a woman who is pregnant with Lupus. 
I do not claim to know everything about Lupus or Lupus in Pregnancy, that why in these scenarios I work with a team. But! I have cared for patients with Lupus in pregnancy and have family and friends with the disease.  This episode is for everyone to learn and understand just a little more about the effects of lupus on the millions of Americans that have been diagnosed with this autoimmune disease.

Transcript

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Hey, guys, Welcome to another episode of four vaginas on Lee. Now it is officially May and May is also Lupus Awareness month. And because I know so many people affected with Lupus and have passed that I passed away from Lupus, I decided to do a podcast episode this month. Dedicated toe Lupus in pregnancy. Hello and welcome to four vaginas. Only the podcast about everything. Female. I'm your host, Dr Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. All right, welcome. If you have never listened to one of these podcasts before, I am Dr Celestine and you are tuned in to four vaginas only, which is a podcast that I've created in order to discuss some common and not so common problems and questions and concerns about pregnancy and gynecology. I am an obstetrician gynecologist, and in this episode, we're going discuss Lupus in pregnancy. And now Lupus affects millions of people around the world. Millions of people just in America alone. And I do see occasionally pregnant women that come in, or people that are desire ing pregnancy that have Lupus and There's actually a lot to go through with them during those visits because there's a lot that needs to be done. There's a lot that needs to be discussed. So I thought that since it's now officially May, and it is Lupus Awareness Month that I will do a podcast episode on Lupus and pregnancy. All right, so to start out officially, there's about 1.5 million Americans that have Lupus. That's what it's estimated to be, according to the CDC, and African Americans are actually three times more likely to have Lupus than white Americans. It is a chronic autoimmune disease that can damage any part of the body. It's mostly diagnosed at ages 15 to 44 which, in terms of what I deal with with Obi joi n that's actually prime childbearing age. That's the age range where most people have their their babies and their pregnancies. It does affect more women than men, and basically what it is is it's the body's immune system, which is its defense system not doing its job. So basically, the body cannot differentiate a virus, a bacteria or a bad germ from healthy cells or healthy organs, so it attacks the entire organ system in a person that has Lupus. There are different types of Lupus. The most common type is called systemic Lupus erythematosus or S L E. For short, and that's the one that affects your entire body. There's also Catania ce Lupus that only affects the skin. There's drug induced Lupus, which can happen with certain medications that are prescribed. And there's also neonatal Lupus, which is Lupus in a baby that has just been born. And I'll talk a little bit more about that later in the podcast as well. Okay, so back in the day, those women that had Lupus were advised not to get pregnant at all, which is no longer the case, but a Lupus pregnancy is still considered very high risk, and there are some things that you can do before you get pregnant and some things that need to be done during pregnancy in order to make sure that we have the healthiest pregnancy and healthiest baby that we can, Um so especially ahead of pregnancy is recommended that you meet with your doctors, including euro be July n, including your high risk obi specialist, which is sometimes a maternal fetal medicine doctor and also your rheumatologist so that we can all be treating you together during the pregnancy, making sure that everything stays as co pathetic as it possibly can. Now this preconception counseling and preconception discussions with your doctors, it's recommended that you do those at least six months before even getting pregnant. So that's very important for those women out there with Lupus To hear at least six months before you're trying to get pregnant or getting pregnant, make sure you meet with all of your doctors. Make sure that we have all the ducks in the row and everything as controlled as we possibly can. Now there are still some cases where those with Lupus should not be getting pregnant, such as those with uncontrolled high blood pressure even prior to pregnancy. Those with lung disease, especially severe lung disease, heart failure or kidney failure. In those cases, pregnancy is not generally recommended, and usually well, I should say in some cases we should at least work on controlling these issues before pregnancy happens. If that is the plan now, another reason why we need to see you early on before you get pregnant is because there's some medications that you need to take and some labs that we need to do before you get pregnant in order to ensure the safety of you and your baby. So some medications that you take for Lupus, such as methotrexate, eights that's contraindicated in pregnancy so we can't give you that on the opposite side. Prednisone, for example. We can give him pregnancy in most cases, and that can possibly be continued or added onto your medications in order to control a Lupus flare and control the Lupus during the pregnancy. Now Lupus doesn't necessarily block you or inhibit you from becoming pregnant in in and of itself. But like I mentioned, once you get pregnant, it is a high risk pregnancy. A little under 50% of women with Lupus that are pregnant have some sort of pregnancy complication. For example, there's an increased risk of miscarriage is with Lupus not so often in the first trimester, although possible, but a lot of times it can happen later on in the pregnancy because of something called anti foster lipid antibodies, which is something that we check for in all Lupus patients. And it's important to know if you. The woman that has Lupus has these antibodies, especially prior to becoming pregnant, because having those antibodies could also increase the risk of blood clots, which can potentially kill you during the pregnancy. If that were to happen, which I hate to say, I hate using words like kill and die and death, but unfortunately, that's the reality of some situations. Also, anti fossil lipid antibodies can increase the chance of having in tree during growth restriction a small baby which can have its own set of complications. And sometimes we need to deliver early for that. In addition to that, you can also have preeclampsia and high blood pressure and something else known as help syndrome, which are all kind of lumped together. Just having high blood pressure is one thing, but pre eclampsia is when you have high blood pressure with protein in the urine, which can lead this way down another rabbit hole of things to discuss. But it's a very severe complication of pregnancy that sometimes leads to us. Delivering your baby early sometimes can lead to fetal demise as well, so that's something that's very that can happen in Lupus patients. And it's estimated that around 20% of Lupus patients will get pre eclampsia. Help syndrome is another kind of offshoot of preeclampsia. It's another kind of a little more severe version of preeclampsia as well. And speaking of delivering early preterm delivery or preterm birth is a complication of Lupus as well. Something that can happen doesn't always have to. None of these don't always have to, but they can, and it could be. Four reasons, such as the pre eclampsia that we mentioned earlier or the Yogi are as well the intruder and growth restriction. Having a very small baby can sometimes me, that we need to deliver early, because the baby being in the womb is a little bit more dangerous at a certain point in the baby being out of the womb in a pregnancy of a woman that has Lupus. Now all these things may not happen. You might get all of them happening at the same time, you might get none of them at all. There's no way for us to know 100% but because of such a high chance of these things happening, that's why a Lupus pregnancy is so high risk now. Ah, high risk pregnancy involves having very frequent doctor visits. We have to monitor the baby's grilled. We have to monitor your blood pressure at the monitor your labs constantly to make sure that we're not missing something. We're not missing any Lupus symptoms or Lupus flare ups or complications with the pregnancy. Now with Lupus flares, it's difficult and pregnancy sometimes to tell the difference between a Lupus flare and just a symptom of pregnancy. Because you could have symptoms such as swelling. Which those have you been pregnant before? Know that that's very common in Lupus. You can also have a face rash, um, joint swell in particular fluid accumulation in different compartments of the body. I mean, it's very hard to tell, but that's why we have to keep such a close eye on you. Between your o b g y n like me, a high risk over joy in such as a maternal fetal medicine specialists and your rheumatologist altogether have to work in order to make sure that the pregnancy is healthy and stable, and we get a nice, healthy baby and mom at the end. Okay, so another complication of Lupus just a touch on the baby very quickly is something called neonatal Lupus, so a child can be born with some of the signs and symptoms of Lupus, such as having a skin rash, such as having liver complications. Low blood cell counts. Now these symptoms of neonatal Lupus usually go away within six months. But there is a fetal complication with Lupus that can be a little bit more long, lasting or permanent even, and that is congenital heart block Now. Congenital heart block comes from certain antibodies that we have to test for early in pregnancy as well, and especially if you have these antibodies we monitor. The fetus is heart while you're still pregnant, and also, sometimes they get some monitoring after they deliver as well, I believe, and these antibodies are known as anti roe and anti law. And if the's are present in a woman that has Lupus, there is a risk of having this feel congenital heart block, which can be devastating. It depends on if it's a complete or in complete heart block. A complete heart block has a high mortality rate. The Children of the wear pacemakers permanently Um, so it's something that we monitor very closely during the pregnancy. Luckily, it's rare. From what I've seen in my research, I don't mean I don't do Pedes that much, but from what I see, it's only about 1 to 5% of babies who are born women with systemic Lupus have this. Um, But when it does happen, no matter how where it is, it's devastating to that family. And for that child, Now, you know me for four vaginas only. I am always a big advocate in taking charge of your own health care. So, yeah, all of this sounds probably like something that you can't do or can't control. But like I mentioned earlier, the first thing you could do is know that you have this diagnosis, obviously, and then make sure that you see your doctors at least six months before trying to conceive, and that will make sure that you're a healthy as you possibly can be before pregnancy. Now, preconception counseling is recommended for everybody so that they could be as healthy as possible, but especially in those with high risk diseases such as Lupus. In addition, you can do your part during the pregnancy. Make sure you see your doctors as they have scheduled you and follow their instructions. I know it seems simple blood dressed as an overdue I am. There are many patients out there that don't follow the instructions that I give them, and sometimes that can have devastating effects. And in this case with Lupus, it's even Maur important that you're closely seeing and closely monitored. So just schedule with your doctors. Go to your appointments and make sure you follow their instructions. Also, pay attention to your body. Ah, lot of these women that I've seen that have Lupus either outside of pregnancy, like my friends and family or while they're pregnant, such as my patients. They have had Lupus for a little bit of time. They know some of the symptoms that usually come with their own personal Lupus flare. Lupus affects everybody a little bit differently, right, so they know kind of what there's feels like to them. So be aware of and pay attention to what your body is telling you during the pregnancy. And if there is any, I mean any doubt as to whether it's pregnancy related or Lupus related. Make sure you contact your doctor right away, and we can help you delineate that and figure that out and make sure that you're staying healthy during your pregnancy. And that is all for this episode. So thank you so much for listening to another episode of four vaginas on Lee. Thank you for listening to this Lupus in pregnancy episode. It's very important, and it's very near and dear to my heart. I've seen I've had patients in the past that I've grown very close to and have had pregnancy losses because of Lupus. And I have a lot of family members and friends that have Lupus or have passed away from Lupus and, you know, in my field, especially, they talked to me about planning pregnancy, wanting a child and things like that because everybody, not everybody. Most people, um, you know, regardless of what disease they have or what condition they have with like to have a baby one day. So it's important that you have these discussions with your doctors early as possible. It's important that you, if you can, which I know it's hard in some cases, but tryto get your Lupus under control as much as you possibly can. It's even better if you've been in remission for quite some time before getting pregnant. But I know that's not always possible, but just the best control and be under the best care that you possibly can before you get pregnant. Pregnancy stresses your body out, so anything that you can do to decrease such tres prior to becoming fragment is always ideal. So thank you so much for listening to this podcast. Please let me know if you have any questions. You can always write to me at four vaginas on Lee on Instagram or Facebook. You can also email me at Dr C at f ve Onley dot com And I hope to hear from you guys soon and stay tuned for the next four vaginas only episode in the very near future by