“Don’t do it. Don’t even think about it. If you try, you die.” Those harsh, penetrating words are seared on my memory bank like a branded cow. What circumstances prompted such grim advice you ask? What was I attempting to do? Jump out of an airplane? NOPE. Run with the bulls in Pamplona? NOPE. Swim in a shark tank? NOPE. I was simply trying to do what women have done since the dawn of time and what women continue to do 255 times every minute of everyday…have a baby. So why the inauspicious hoopla? Well, let me explain – I have lupus and one of the most highly debatable conversations among patients with lupus and their doctors is whether it is safe or even possible to become pregnant.
A few years ago, when I approached my doctors regarding my desire to begin my journey to become a mother; I was made to feel that lupus and pregnancy were about as compatible as oil and water. They don’t mix well – so don’t go there. Being a stubborn individual, of course I did go there but I didn’t take the first “no” for an answer. I didn’t take the second, third or forth “no” for an answer either. Although my stamina started to dwindle when even the high-risk doctors gave me the bleak scenario rundown. Behind door number one: kidney failure. Behind door number two: miscarriage and pre-term birth. Behind door number three: preeclampsia and possible death. Well doesn’t that sound like a jolly holiday? Hmm…which door do I choose?
Thankfully, a recent study done at the Hospital for Special Surgery in New York is providing lupus patients with a more hopeful scenario. Dr. Jane Salmon and her pioneering team of researchers have shown that most women can expect a good pregnancy outcome if their lupus is inactive and they are free of certain risk factors! Their findings are a culmination of a ten year study known as PROMISSE (Predictors of Pregnancy Outcome: bioMarkers In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus) and was launched to help identify risk factors that predict poor pregnancy outcomes in women with lupus and antiphospholipid antibody syndrome. “In the past, lupus patients were advised not to become pregnant because of potential risks to their health and that of their baby” Dr. Salmon states, “Our findings provide a clear direction for counseling patients and reassuring women with inactive lupus. We also learned that patients with specific clinical features and certain antibodies that can be detected early in pregnancy by blood tests have an increased risk of serious pregnancy complications.”
Of the 385 multi-ethnic pregnant women who were enrolled in the study, 81% of the pregnancies were free from complications. The women who were involved in this study all had inactive or stable to moderate lupus disease activity at the time of enrollment but had at least one or more risk factors: a specific antiphospholipid antibody in the blood, a history of hypertension, and/or a low platelet count. Dr. Salmon seems extremely optimistic about these positive results, “It was exciting to see that severe lupus flares occurred in less than three percent of women during pregnancy,” said Dr. Salmon. “Lupus patients and their doctors can be confident of a good pregnancy outcome in most cases if lupus is quiescent when they become pregnant. Our findings now allow clinicians to identify the patients at high risk and manage them accordingly.”
This is incredibly uplifting news for women in the lupus community (insert happy dance here)! I hope that this article from Dr. Salmon and her team inspires other women who are diagnosed with this disease to know that just because they have lupus, doesn’t mean that they have to give up their dream of becoming a mother. Lupus and pregnancy may not be the best scenario, but now we know it is not the worst and it is definitely worth playing out. I personally was not seen by Dr. Salmon and did not participate in this study.
However, I did finally find a high risk OB/GYN and an amazing rheumatologist that would take a chance on treating me while I was pregnant. At the time, my lupus was stable but my history of hypertension and kidney issues was disconcerting. Thankfully, for all intent and purposes, I had a normal pregnancy. I was induced at 37 weeks when my hypertension came back, then had a cesarean section in the end due to fetal distress. However, my little boy was born healthy and I recovered without any complications. I wish I had read this study when I was told lupus and pregnancy was a no-no. Because to me…it was a big yes-YES and I have never regretted my decision to become a mommy. Back to top
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