QuestionI recently took a home pregnancy test and it came back positive, but I'm extremely worried about this pregnancy because I've diagnosed for SLE and have been on lovenox and now coumadin since August of this year. what should I do?
AnswerDear DeNesha,
The perception that SLE pregnancies are of particular high risk is not necessarily accurate anymore. There have been vast improvements in disease management and perinatal monitoring which have resulted in a significant decrease in pregnancy losses and fewer preterm deliveries. A recent article I saw noted that the rate of loss in lupus pregnancies decreased from as high as 43% before 1975 to 17% in 2000-2003.
Women in SLE remission have much less trouble than do women with active disease. And obviously general good health recommendations are absolutely necessary - eat a well-balanced diet, take medications as prescribed, visit your doctor(s) regularly, don't smoke, don't drink, and certainly don't use "recreational" drugs.
About 20% of women with SLE will have a sudden increase in blood pressure, protein in the urine, or both during pregnancy. This is called toxemia of pregnancy (or pre-eclampsia, or pregnancy-induced hypertension). It is a serious condition that requires immediate treatment and often immediate delivery of the baby. Toxemia is more common in older women, in black women, in women with twins, in women with kidney disease, in women with high blood pressure, and in women who smoke.
Most medications commonly taken by those with SLE are safe to use during pregnancy: prednisone, prednisolone, and probably methylprednisolone (Medrol) do not get through the placenta and are safe for the baby. But others, specifically dexamethasone (Decadrol, Hexadrol) and betamethasone (Celestone) do reach the baby and are used ONLY when it is necessary to treat the baby as well.
Obviously you will need to have an OB doctor who is familiar with SLE or who will be consulting with your SLE doctor on a regular basis throughout the pregnancy. But I would not be afraid to proceed with the pregnancy simply because you have the SLE diagnosis -especially if you are currently pretty healthy.
I hope this has helped you and answered your question. I wish you well.
Happy Halloween and make sure that WOMEN'S voices are heard by voting!!
Brenda
