It is possible for a person with lupus to safely become pregnant without triggering flares, as long as they are able to manage their condition. However, it is safest to begin planning for pregnancy well in advance.

Although an individual with lupus may be able to navigate pregnancy and lupus safely, there are associated risks.

Around 2 in 10 pregnant people with lupus get preeclampsia, a serious condition that requires immediate treatment. Other serious complication risks include kidney problems, diabetes, and high blood pressure.

This article examines lupus and pregnancy, what to expect, and more.

Trigger warning: This feature mentions pregnancy loss, stillbirth, or both. Please read at your own discretion.

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Lupus can affect having a baby in some cases. While most people with lupus can have healthy pregnancies, doctors consider these pregnancies high risk.

Planning for pregnancy

Planning can help reduce pregnancy risks for people with lupus.

It is best to try to avoid becoming pregnant while lupus is active, as this could result in serious health problems. It can also lead to pregnancy loss and stillbirth.

The Centers for Disease Control and Prevention (CDC) recommend a person wait until their lupus has been in remission for at least 6 months before trying to become pregnant.

Higher risk pregnancies

Pregnancy may be very high risk for people with lupus and certain co-occurring conditions, including those who have:

People with lupus may find it difficult to conceive due to the need to schedule trying to become pregnant around flares. Lupus can also lead to fertility challenges.

Factors doctors associate with infertility that lupus may cause include:

  • Secondary amenorrhea: Lupus may cause menstruation to cease, affecting a person’s ability to conceive.
  • Ovarian failure: Some medications doctors prescribe for lupus, such as cyclophosphamide, can keep a person’s ovaries from producing eggs.
  • Chronic kidney disease: Doctors associate chronic kidney disease with reduced fertility and a higher risk of adverse pregnancy outcomes.

Can a person pass lupus on to a fetus?

People may worry about the health of their newborn and whether they can pass lupus on to a fetus during pregnancy.

Most infants born to people with lupus are healthy. In rare cases, they can have a condition called neonatal lupus, where certain antibodies from the parent transfer to the fetus. These infants may present with liver problems, skin rashes, and low blood cell counts at birth.

Neonatal lupus typically goes away within 3–6 months. However, the condition can result in a severe heart problem called congenital heart block in some cases.

Doctors will test for neonatal lupus during a person’s pregnancy and can begin treatment before birth if it is present.

Pregnancy can increase the risk of complications in people with lupus. These include the following:

Flares

Pregnancy may cause lupus flares, during which a person’s symptoms can worsen. These are most common during the first and second trimesters and are usually mild.

However, a person will need to seek treatment as soon as they notice warning signs of a flare, even if they suspect it will be mild, as some may cause early delivery or damage to internal organs.

A pregnant person who experiences any of the following signs of a flare will need to contact a doctor, even if they do not have a lupus diagnosis:

Preeclampsia

This is a dangerous condition that causes a person’s blood pressure to rise suddenly during pregnancy and can lead to blood clotting that can damage internal organs.

Complications related to medication

Other potential complications, which a person may be especially at risk of if they take corticosteroids to manage their lupus, include:

  • kidney issues
  • diabetes
  • high blood pressure

A person may need to review their lupus medication with their doctor if they are pregnant or plan to become pregnant. Although many are safe during pregnancy, the doctor may adjust medication before conception.

Safety of lupus drugs

Medications doctors consider safe for pregnant people include low dose aspirin and hydroxychloroquine.

They consider the following reasonably safe during pregnancy, with certain limitations:

Doctors recommend people with lupus do not take the following while pregnant or trying to become pregnant:

Lupus can increase certain risks during childbirth, including:

Because of these risks, doctors may administer an increased dose of glucocorticoids, called a stress dose, to help control a person’s bodily response to the stresses of childbirth.

While many people with lupus may be able to have an uncomplicated vaginal delivery, doctors may suggest some opt for a cesarean delivery at a hospital equipped with a neonatal intensive care unit.

Doctors consider nursing an infant safe for people with lupus.

Medications to treat lupus, such as prednisone, azathioprine, methotrexate, and hydroxychloroquine, do not transfer into breast milk in large or dangerous quantities. This means that people may usually continue their treatment while nursing.

A person with lupus may experience flares while caring for an infant, as stress and exhaustion may trigger symptoms. For this reason, it is important to pay close attention to warning signals of flares during this time and continue the doctor’s prescribed treatment.

Where possible, people may be able to seek help from friends and family members. Support and assistance with caring for the infant and performing certain day-to-day tasks may relieve some stress.

For in-depth resources on early parenthood and pregnancy, visit our dedicated hub.

Below are answers to some common questions about lupus and pregnancy.

What percentage of pregnant people with lupus experience pregnancy loss?

Fewer than 10–20% of people with lupus who become pregnant experience pregnancy loss.

Does lupus get worse after pregnancy?

Some people may experience flares of lupus symptoms after childbirth. However, this is less likely if people receive treatment to manage their symptoms effectively.

People with lupus can have safe, healthy pregnancies when their lupus is inactive, and treatment allows them to manage symptoms effectively.

However, doctors consider pregnancies in people with lupus high risk, as they may be more likely to experience certain complications. These include preeclampsia, diabetes, high blood pressure, kidney problems, and lupus flares during and after pregnancy,

Pregnancy can put certain people with lupus at higher risk of health complications. Higher risk groups include people with heart failure, chronic kidney failure, lung disease, and high blood pressure.

It can also lead to difficulties conceiving and increases certain childbirth risks, such as premature rupture of the membrane, early delivery, and increased stress, which can cause lupus flares.

A doctor can offer individualized advice on lupus and pregnancy.