Though it is sobering news, it is important for women with lupus to know that about 10 to 20 percent of lupus pregnancies end in unexpected miscarriages or stillbirths. That said, women with lupus who wish to get pregnant certainly can – and can experience a normal pregnancy and delivery, as well. But it is important that a lupus pregnancy be monitored by an obstetrician experienced in managing high-risk pregnancies and who can work closely with your primary doctor.
Generally speaking, first-trimester miscarriages either have no known cause or are considered the possible result of active lupus. Losses in later trimesters for lupus patients can often be attributed to antiphospholipid antibodies or lupus anticoagulant.
Lupus anticoagulant antibodies react with proteins bound to phospholipid, a type of fat molecule that is part of the normal cell membrane, and found in the blood stream. They are categorized as antiphospholipid antibodies.
These antibodies interfere with the normal function of blood vessels and can lead to narrowing of the blood vessels or blood clots, which can lead to miscarriage. Beyond miscarriage, these complications also can lead to stroke and heart attack.
While lupus anticoagulants are typically discovered in systemic lupus erythematosus patients, they are also known to occur in people with other autoimmune diseases, certain infections, and tumors, as well as in people who take certain medications, including phenothiazines, phenytoin, hydralazine, quinine, amoxicillin, and birth control pills.
And while these antibodies were first discovered in lupus patients, you don’t have to have the disease to carry the antibodies. Typically, 50 percent of those that carry the antibodies do not have lupus.
Of course, other factors beyond lupus can contribute to miscarriage. The most common is a chromosomal abnormality in the fetus, usually resulting from a problem with the sperm or egg that prevents proper fetus development.
Second-trimester complications with the uterus or cervix can cause miscarriage. Other disorders, such as polycystic ovary syndrome, increase the risk for miscarriage as well. Remember, though, that women who miscarry can and often carry a pregnancy to full-term.
Signs and symptoms of miscarriage can include:
- Vaginal spotting or bleeding
- Cramping or abdominal pain
- Fluid or tissue passing from the vagina
Note that some vaginal bleeding, specifically spotting early in pregnancy, may not indicate a potential miscarriage. Regardless, contact your health care provider immediately.
Sources:
Antiphospholipid Antibodies Lupus Foundation of America. August 2008.
Lupus Anticoagulant. William Matsui, MD, Assistant Professor of Oncology, Division of Hematologic Malignancies, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. Review provided by VeriMed Healthcare Network. February 2007.
Miscarriage Eunice Kennedy Shriver National Institute of Child Health and Human Development. May 2007.
