Nancy Carteron, MD, FACR
Senior Consultant, Rheumatology Immunology
Clinical Faculty, University of California San Francisco

Most women will conceive and have healthy babies. However, there are potential complications. Consulting your obstetrician (OB-GYN), rheumatologist, and possibly a high-risk OB (perinatologist) prior to conceiving or early in pregnancy is suggested.

Factors contributing to the ability to conceive:

• Age
• Primary ovarian failure
• Endometriosis
• Environmental factors (i.e. pesticides)

Potential pregnancy complications:

• Congenital heart block (SSA/SSB
  autoantibodies; possibly RNP antibodies)
• Neonatal lupus (rash)
• Fetal loss
• Intrauterine growth retardation 
• Premature delivery
• Recurrent pregnancy loss
• Preeclampsia (phospholipid autoantibodies)

Know your autoantibody (blood tests) status:

• SSA (Ro) and SSB (La) – higher levels may carry more risk
• Phospholipid antibody (APL) – Lupus anticoagulant; IgG and IgM cardiolipin antibody; IgG and IgM anti-beta2 glycoprotein I antibody

• First pregnancy – 2 % risk
• If previous child had CHB, risk increases 10-fold for subsequent pregnancy
• Weekly Doppler fetal echocardiogram surveillance between the 18^th and 24^th weeks
• Cardiomyopathy can occur
• Management strategies, including fetal pacemaker available

Neonatal lupus (rash):

• Autoantibodies cross the placenta, decline over several weeks, rash resolves
• If previous child had neonatal lupus, risk increases 5-fold for neonatal rash for subsequent pregnancy

This article was first printed in The Moisture Seekers, SSF's patient newsletter for members. It is also available as an SSF Patient Education Sheet.