Lupus and Scleroderma

Lupus and Scleroderma in Pregnancy 

Lupus and scleroderma are autoimmune diseases more commonly found in women, particularly women of reproductive age.

Autoimmune diseases occur when your immune system mistakenly attacks healthy cells in your body, causing inflammation and damaging tissues and organs. During pregnancy, these conditions can increase the risk of serious complications that threaten the health of mother and baby.

Pregnancies involving lupus or scleroderma are considered high risk. They require careful planning, close monitoring and specialized obstetric care.

About Lupus

Lupus is a chronic autoimmune disease that causes inflammation in the skin and joints. It can also affect multiple organs, including the kidneys, heart, lungs, blood vessels and brain.

Also known as systemic lupus erythematosus or SLE, lupus is a serious and potentially fatal disease depending on the organs involved.

About Scleroderma

Scleroderma is an autoimmune disease that causes your skin and connective tissues – the tissues that support your body’s structure – to harden and thicken. Scleroderma can affect your joints, blood vessels and major organs, including your kidneys, lungs, heart and digestive tract.

Potential Pregnancy Complications 

Women with lupus and scleroderma are at increased risk of pregnancy complications that include:

• High blood pressure/preeclampsia
• Kidney failure
• Thrombosis (blood clots)
• Placenta problems
• Fetal growth restriction
• Premature birth
• HELLP syndrome, a high blood pressure complication that can lead to liver failure and death
• Need for a cesarean delivery (C-section)
• Need for neonatal intensive care unit (NICU) admission
• Congenital heart block, a condition that prevents the baby’s heart from beating normally
• Risk of neonatal lupus syndrome
• Miscarriage
• Stillbirth

Preconception Planning – Pregnancy Timing is Key

Careful timing is critical to reducing pregnancy risks and improving outcomes. 

• Women with lupus are advised to try and time their conception when the disease has been in remission for at least 6 months.
• Women with scleroderma are advised to delay pregnancy for 3 to 4 years after the onset of their symptoms.

If you have lupus or scleroderma and are considering pregnancy, visit with your health care provider before you become pregnant to:

• Assess your risks
• Achieve and maintain disease remission
• Time your pregnancy for the best possible outcomes
• Review and adjust your medications to reduce risks to the fetus
• Begin prenatal vitamins to help prevent birth defects

Treatment for Pregnancies with Lupus and Scleroderma

Treatment should be tailored to your unique condition and symptoms, your pregnancy and the health of your unborn baby.

In general, if you are pregnant and have lupus or scleroderma, your treatment may include:

• Specialized high-risk obstetric care
• Close monitoring for early detection and treatment of complications
• Close collaboration with your current health care providers
• Medications to control disease symptoms, adjusted as needed at each stage of pregnancy
• Immediate treatment of disease flare-ups to reduce maternal and fetal risks
• Ultrasounds to monitor fetal growth and well being
• Fetal echocardiograms for early detection of congenital heart block
• Anesthesiology consultation
• A carefully planned delivery
• An experienced, multidisciplinary healthcare team that may include maternal-fetal specialists, rheumatologists, fetal cardiologists, pediatric cardiologists, nephrologists, dermatologists and other specialists as required by your condition 

Benefits of Specialized Care

Texas Children’s Pavilion for Women offers specialized care to help women with lupus and scleroderma achieve the healthiest possible pregnancy. Our maternal-fetal medicine specialists are experienced in evaluating and managing these high-risk pregnancies, carefully assessing and balancing the treatment needs of the mother with the health and safety of her unborn baby.

Benefits include: 

• Preconception counseling to assess and reduce maternal and fetal risks
• Expert prenatal consultations, evaluations and treatment
• Close collaboration with your current health care providers
• Proven experience coordinating the multidisciplinary care required to optimize outcomes in these complex pregnancies
• State-of-the-art fetal imaging for early detection of abnormalities
• Delivery at the Pavilion for Women’s leading-edge facility, equipped to respond to life-threatening complications and emergencies
• Seamless access to Texas Children’s Hospital and specialists for babies who need extra care and monitoring, including the Texas Children’s Fetal Center® and Texas Children’s Newborn Center®, home of our level IV NICU
• A multidisciplinary team of specialists experienced in addressing the needs of mothers and babies in pregnancies with lupus and scleroderma
• Access to specialists in autoimmune and rheumatic disease at Baylor College of Medicine’s Rheumatology Clinic