Pregnancy can cause flare-ups of autoimmune conditions, which can lead to complications that may be mild to life threatening for the mother, baby, or both. Your NYU Langone rheumatologist may prescribe medications to treat these problems.
Certain types of autoimmune conditions, including antiphospholipid syndrome and lupus, can cause blood clots to form during pregnancy, so your doctor may prescribe an anticoagulant—a blood thinner. These medications can increase the risk of bleeding in both mother and baby; your doctor carefully monitors the effects through regular blood tests.
Some women who test positive for the lupus anticoagulant, a type of antibody that can cause blood clots in women with lupus or the antiphospholipid syndrome, may be given low-dose aspirin or aspirin and a blood thinner called heparin to reduce the serious risk of blood clots.
Medication may be prescribed for women with mild to moderate symptoms of preeclampsia, a pregnancy-induced high blood pressure. Some blood pressure medications are dangerous for the baby, so your rheumatologist, maternal–fetal medicine doctor, or obstetrician prescribes only medications considered safe.
Your doctor may also recommend bed rest and extra monitoring, which can include urine tests and blood pressure checks. Women who have severe preeclampsia must deliver their babies, even if the baby is not full term, or 37 weeks. Premature babies are treated at our Neonatal Intensive Care Unit.
Lupus nephritis is a kidney disorder that affects many people with lupus. It may cause no symptoms at all, or it may cause headaches, swelling of the eyes upon waking, and swelling of the legs. Left untreated, lupus nephritis can be very serious and lead to kidney failure and the need for dialysis or kidney transplant.
It is important to avoid becoming pregnant if you are having a kidney flare-up and your urine contains more than a gram of protein within 24 hours. Active nephritis at the start of pregnancy increases the risk of preeclampsia, low birth-weight babies, preterm birth, and worsening kidney function. Monitoring of protein in the urine is very important during pregnancy and is done at each visit.
Treatments for lupus nephritis include medications that may not be considered safe for the baby, such as certain immunosuppressants or types of anti-hypertensives, which can cause birth defects or miscarriage when taken during pregnancy. Thus, these medications have to be stopped before pregnancy, and should not be used even if lupus nephritis occurs during pregnancy.
If your kidneys do flare during pregnancy, your doctor may prescribe steroids to help reduce kidney inflammation. Your doctor weighs the risks of each of these medications and discusses the options with you.
If you develop complications that pose a danger to the baby, you may need to deliver early. NYU Langone’s Neonatal Intensive Care Unit is equipped to treat babies born before 37 weeks.
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