Diagnosing Pregnancy Complications of Autoimmune Diseases

If you have lupus, antiphospholipid syndrome, rheumatoid arthritis, scleroderma, or Sjogren’s syndrome, you can have a healthy pregnancy with proper counseling and care. At NYU Langone, our rheumatologists, maternal–fetal medicine experts—doctors who specialize in high-risk pregnancy—and obstetricians monitor the health of women with an autoimmune disease before, during, and after pregnancy.

Diagnostic Tests 

Your NYU Langone doctor performs tests before and during pregnancy to assess your risk for complications. In addition, doctors always monitor your weight. Rapid weight gain can signal preeclampsia, in which a pregnant woman develops high blood pressure, and women with autoimmune conditions are at a higher risk for preeclampsia. Throughout pregnancy and after birth, our doctors check the health of both mother and baby.

Blood Tests

Your doctor may order a blood test to assess your risk for pregnancy complications, such as blood clots, growth problems with the baby, congenital heart block—a condition the baby is born with, in which the heart beats too slowly—and miscarriage

Pregnancy can stress organs affected by an autoimmune disease, so your doctor may perform blood tests to check your kidneys and liver before and during pregnancy, either monthly or every trimester. 

Blood Pressure Measurement

Women with autoimmune diseases may be at increased risk for preeclampsia. Doctors watch your blood pressure closely during pregnancy. If your blood pressure rises, they may also recommend using a home blood pressure monitor between office visits. 

Echocardiogram

For women who have anti-Ro antibodies—substances in the blood that mistakenly attack the body’s own tissues—regardless of whether they have lupus or Sjogren’s syndrome, our doctors recommend a weekly fetal echocardiogram be performed from about 16 weeks of pregnancy through 26 weeks. 

This is done to check for early signs of damage to the baby’s heart. Fortunately, this type of heart problem is quite rare. 

Urine Tests

To make sure your kidneys are working properly, doctors routinely test your urine for the presence of protein. An increased amount of protein in the urine may be a sign of lupus or preeclampsia. Preeclampsia is also accompanied by high blood pressure and, if serious, may require delivery of the baby, even if it means the baby is born prematurely.  

Preeclampsia and HELLP Syndrome Testing

Women with autoimmune conditions are at higher risk for preeclampsia and HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), a life-threatening liver disorder that can occur during pregnancy. Left untreated, preeclampsia can lead to eclampsia, which can lead to seizures and coma.

Preeclampsia

When preeclampsia occurs, it typically begins after 20 weeks of pregnancy. Symptoms include abdominal or shoulder pain, changes in vision, headache, nausea, shortness of breath, unusual and sudden weight gain, severe ankle swelling, and vomiting. Women with hypertension before pregnancy are at increased risk for preeclampsia.

To diagnose the condition, your NYU Langone doctor performs a physical exam to check for high blood pressure and swollen ankles or legs; tests your blood for low levels of platelets, which help the blood clot, and liver abnormalities; and checks the urine for elevated amounts of protein. 

The doctor also checks the baby’s heart rate and performs an ultrasound to assess the baby’s size, which can reveal if the baby isn’t growing properly. Poor growth may require delivery of the baby, possibly preterm. 

HELLP Syndrome

HELLP syndrome is a rare condition that typically occurs in the third trimester of pregnancy. The symptoms may be vague and might include a general malaise, or an overall feeling of being unwell, and a gastric pain that can mimic a stomach virus. The cause of HELLP is unknown. HELLP almost always requires immediate delivery of the baby, even if preterm.

To diagnose this condition, your NYU Langone doctor performs a physical exam to check for high blood pressure and checks your liver function and platelet levels through blood tests.

If you are experiencing a severe headache or any of the symptoms of preeclampsia or HELLP, call your doctor or 911 immediately.

Lupus Nephritis Testing

Lupus nephritis is a kidney disorder that may affect people who have lupus. Some women with the condition experience no symptoms. Others have headaches, swelling of the eyes upon waking, and swelling of the legs. Left untreated, lupus nephritis can lead to kidney failure, which may require dialysis or a kidney transplant. 

Lupus nephritis increases a woman’s risk that a pregnancy ends in miscarriage or stillbirth. As a result, women with lupus nephritis are advised to wait until they’ve been in remission for six months before trying to conceive. Active lupus nephritis at the start of pregnancy increases the risk of preeclampsia, preterm birth, worsening kidney function, and slowed growth for the baby. 

Your doctor monitors the protein in the urine throughout pregnancy to check for lupus nephritis.

Preterm Labor Signs

About one-third of pregnant women with lupus and more than one-quarter with rheumatoid arthritis deliver a baby preterm, meaning prior to 37 weeks of pregnancy (when the baby is considered full term). Your NYU Langone obstetrician monitors your pregnancy for signs of preterm labor, such as a heavy feeling in the pelvis, cramping, spotting or bleeding, backache, intermittent pelvic pain or uterine contractions, and an increase in vaginal discharge. However, some women may not experience noticeable symptoms. 

If you are experiencing symptoms of preterm labor, contact your obstetrician or perinatologist immediately. He or she may give you medication to stop preterm labor. Experiencing preterm labor doesn’t necessarily mean the baby is delivered prematurely.

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