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A New Free Report - What Is Lupus?
This fascinating new report from UK-based publishing house Health Research Today answers some of the most-asked questions about this baffling disease :
- What is the medical definition of lupus?
- What are the symptoms of lupus?
- What tests are there for lupus? How do you get a diagnosis?
Fill in this form and we will send you the report immediately, which you are welcome to send on to friends or family!
Lupus and Women
This article is an extract from the ebook Freedom From Lupus!
Hughes Syndrome and Pregnancy
Hughes syndrome, or antiphospholipid syndrome, is associated with a greater risk of miscarriages in pregnant women. Approximately one-third of women with SLE have antiphospholipid antibodies present, and they have a miscarriage rate of between 20 and 50 percent. Approximately 15 percent of women who have had three or more miscarriages also have positive tests for Hughes syndrome, and most of the miscarriages associated with Hughes syndrome occur in the second or third trimester.
Women with Hughes syndrome also have higher risks of complications like pre-eclampsia, slowing of the baby’s growth in the uterus, and premature delivery. Miscarriages often result from a clot forming in the placenta, making it difficult for the fetus to get the nutrients needed for survival.
That is not to say that there is not hope for women who have Hughes syndrome. Women who receive treatment for Hughes syndrome during pregnancy see a successful pregnancy rate of 85 percent. While there is no one way to treat Hughes syndrome during pregnancy, many doctors use combinations of baby aspirin, subcutaneous heparin, or moderate doses of prednisone. Some also use plasmapheresis to filter the blood.
Risks to the Baby
Some mothers are concerned that their baby will have lupus or that their disease poses a threat to the fetus. While there are some inherent risks in pregnancy, there is only a 10 percent chance that a female baby will develop lupus if born to a lupus parent. The percentage for male babies drops to 2 percent. Yet approximately 50 percent of those children will carry autoantibodies in the blood and 25 percent of them will develop an autoimmune disease at some point in their lives.1
The presence of the anti-Ro and anti-La antibodies is of more concern to physician. If they are not present, there is little risk of the baby being born with lupus. If the antibodies are present, there is a 5 percent chance that the baby will develop subcutaneous neonatal lupus, which is benign and disappears in a few months.
A greater risk facing the fetus is the greater chance the mother will develop pre-eclampsia or toxemia. The increase in blood pressure, protein in the urine, and fluid in the tissues can place undue stress on the fetus. In some cases the doctor may have difficulty in differentiating the pre-eclampsia from a flare. However, both can be treated with medication like low-dose corticosteroids.
Neonatal Lupus
Some women worry that neonatal lupus will occur with their babies, as the presence of the anti-Ro and anti-La antibodies do increase the risk. However, most mothers with lupus that also have the antibodies need to realize that the risk of having a baby with neonatal lupus is low, and in most cases the disease goes away within a few week with little side effects.
There are three main symptoms found in babies born with neonatal lupus. There can be a rash scattered over the body. The baby can also have an abnormal blood count. There is a third abnormality, but it is very, very rare, which is congenital heart block. Even with the congenital heart block there are treatments available such as medications and pacemakers. Only a small number of babies die from the heart disease.
The mother who has either the anti-Ro or anti-La antibodies have a 25 percent chance of delivering a child with the rash or blood abnormalities. If a woman has both antibodies, the risk for having a baby with congenital heart block does increase. If a woman has one child born with neonatal lupus, the risk of having a second baby with the disease remains about the same.
Breastfeeding
Some women worry about breastfeeding when they have lupus. First, lupus cannot be passed to the baby through breast milk, so in that sense it is not dangerous for women with lupus to breastfeed their babies. However, there is an increased risk of passing medications through breast milk. Then general rule of thumb that doctors use is if the medication is safe to take during pregnancy, it is safe to take while breastfeeding, but a woman should consult with her physician first.
There may be some reasons, though, that a woman may not be able to breastfeed. In some cases the medication may interfere with milk production, which makes it difficult for the baby to get enough nutrition. Also, some women see an increase in flares after pregnancy, so they may not be well enough to breastfeed right away. In other cases, babies may not be able so suckle effectively due to being born prematurely.
If breastfeeding becomes difficult, a woman does have options. Pumping breast milk and feeding from a bottle can be an option if a woman is set on offering breast milk. In other cases, a physician can recommend a good formula. Many new mothers do a combination of breast and bottle-feeding.
Contraception
A 2005 study in the New England Journal of Medicine showed that many patients with lupus could safely use oral contraceptives to prevent pregnancy, though women with a high risk of thrombosis and those with antiphospholipid antibodies were excluded from the study.19 Prior to this study women with lupus were discouraged from using any oral contraceptives due to the belief that the slight increase in estrogen could cause flares or increase the risk of blood clots.
While many women use birth-control pills as contraception, others use them to regulate or relieve pain in a menstrual cycle. Yet due to the estrogen levels in some birth control pills, flares can occur in patients who take them. If a patient does begin birth control pills and has a flare, it needs to be reported to the physician right away and that pill needs to be discontinued. Most physicians will avoid high-dose estrogen pills due to the increased risk of flares, instead opting for low-dose estrogen or progesterone pills. While progesterone-only pills may not be as effective as pills that contain estrogen, they are effective at regulating periods, minimizing menstrual symptoms, and they do not carry the risk of inducing a lupus flare.
- Still, if a patient is considering going on a birth control pill, there are some criteria that should be met first:
- Testing and a clinical examination should be completed to determine the course of the lupus.
- The lupus should be under control or in remission.
- Medicinal requirements should be minimal and there should be no interference between the birth control and the medication.
- There should be a minimal risk of blood clots.
- Low-estrogen or progesterone-only pills should be prescribed.
- The physician should monitor the patient carefully and any flares need to be reported.
Many women opt out of taking birth control pills either because they cannot due to their level of risk or they do not want to take a risk of blood clots or flares. There are other contraceptive options for women who do not take birth control pills. Condoms, spermicides, and diaphragms are all effective forms of birth control. There is currently debate as to whether the IUD is an appropriate form of birth control in patients with lupus due to a potential increase in infection risk.
HRT
HRT, or hormone replacement therapy, is used in preventing osteoporosis in menopausal patients. Some doctors do not like to use HRT for their lupus patients due to the belief that the estrogen in the HRT will worsen symptoms associate with lupus or cause a flare. However, the purpose of HRT is to replace the natural level of estrogen that was present in the body prior to menopause. There is currently no scientific evidence that taking HRT will make lupus worse.20
Some lupus patients, though, find that they do not get to enjoy the benefits of entering menopause. Many menopausal patients find that their lupus symptoms decrease due to the decrease of estrogen in the body, and with HRT they may not get to experience that relief. However, HRT is often prescribed to prevent dangerous bone loss. Even the risk of breast cancer (after taking HRT for 10 years or longer) is not as great as the risk of fatal bone fracture. Sine many lupus patients are at an increased risk of bone loss due to certain medications, HRT may be necessary.
Read the rest of this article in Freedom From Lupus!
© Health Research Today
