Preeclampsia with Lupus

[debbi]

I have had Lupus since age 9, and after careful consideration and consultation with many specialists including my rheumatologist and Perinatologists, we decided to try and conceive. Almost two years ago at age 27 I became pregnant with my first child. Fourteen weeks into the pregnancy, I developed Preeclampsia. During the nightmare that is Preeclampsia, we had to terminate the pregnancy to save me from getting any sicker. This is my question: We are now considering another pregnancy. We have tested for possible culprits as to why I got sick so early, including antiphospholipid syndrome and others. My antiphospholipid tests are sometimes positive and sometimes negitive. So, as a precaution, I am now on 4 mg of folic acid a day (elevated homocystine enzyme), low dose aspirin (81 mg/day), Prednisone (15 mg/day), Placquinil (400 mg/day), and have been told that if I do get pregnant, Heparin injections immediately. Are there any other precautions I can take to help minimize my chances of going through this again? Diet modifications that might help? Thank you!

Debbi

[expert on call]

The most important issue is the level of lupus activity you are experiencing. Preeclampsia at 14 weeks is very unusual and, when it happens, is usually driven by another disease process such as lupus. It is very difficult to tell a lupus flare from preeclampsia.

Some rheumatologists consider a very aggressive approach to lupus prior to pregnancy. Patients can be treated with drugs used in chemotherapy. Sometimes the results are very dramatic - not always. I cannot tell if such an approach could help you. (You would need to discuss it with your rheumatologist). There can be significant complications which include injury to your ovaries that would reduce your fertility-- a hard choice.

Is you blood pressure normal? Is your renal function normal? Do you have protein in your urine? If there is protein in your urine, treatment with a class of antihypertensive agents (ACE-inhibitors) can reduce the proteinuria. These drugs are not used in pregnancy but can be stopped in the first months of pregnancy without risk.

Expert on Call

Information provided on this site is provided for informational purposes only and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disorder, or prescribing any medication. The Preeclampsia Foundation presents all data as is, without any warranty of any kind, express or implied, and is not liable for its accuracy, for mistakes or omissions of any kind, nor for any loss or damage caused by a user's reliance on information obtained on the site. Professional opinions on this condition vary greatly. The Preeclampsia Foundation endorses no one course of treatment or "cure". Responses generated by our Experts to specific questions are based on information anonymously submitted to this site via email, are not based on a complete review of any patient’s medical records and should not be construed as the only reasonable expert response to the info submitted and/or the scenario described.