The key to successful management of SLE is regular contact and communication with the doctor, allowing monitoring of symptoms, disease activities, and treatment side effects.

How can lupus affect pregnancy or the newborn?

Patients with SLE who become pregnant are considered "high risk." Women with SLE who are pregnant require close observation during pregnancy and delivery. This includes fetal monitoring by the obstetrician during later pregnancy. These women can have an increased risk of miscarriages (spontaneous abortions) and can have flares of SLE during pregnancy. The presence of phospholipid antibodies, such as cardiolipin antibodies or lupus anticoagulant, in the blood can identify patients at risk for miscarriages. Cardiolipin antibodies are associated with a tendency toward blood clotting. Patients with SLE who have cardiolipin antibodies or lupus anticoagulant may need blood thinning medications (aspirin with or without heparin) during pregnancy to prevent miscarriages. Other reported treatments include the use of intravenous gamma globulin for selected patients with histories of premature miscarriage and those with low blood-clotting elements (platelets) during pregnancy. Pregnant women who have had a previous blood clotting event may benefit by continuation of blood thinning throughout and after pregnancy for up to 6-12 weeks, at which time the risk of clotting associated with pregnancy seems to diminish. Plaquenil has now been found to be safe for use to treat SLE during pregnancy.

Lupus antibodies can be transferred from the mother to the fetus and result in lupus illness in the newborn ("neonatal lupus"). This includes the development of low red cell (anemia) and/or white blood cell and platelet counts, and skin rash. Problems can also develop in the electrical system of the baby's heart (congenital heart block). Occasionally, a pacemaker for the baby's heart is needed in this setting. Neonatal lupus and congenital heart block are more common in newborns of mothers with SLE who carry antibodies referred to as anti-Ro (or SS-A) and anti-La (or SS-B). (It is wise for the newborn baby's doctor to be made aware if the mother is known to carry these antibodies. Risk of heart block is 2%, risk of neonatal lupus is 5%.) Neonatal lupus usually clears after six months of age as the mother's antibodies are slowly metabolized by the baby.