Lupus and Pregnancy: Your Essential Planning Guide

Living with lupus (systemic lupus erythematosus, or SLE) can make pregnancy feel like a giant question mark. But here’s the good news: most people with lupus can absolutely have healthy pregnancies — it just takes extra planning, careful monitoring, and the right support team. Whether you’re already pregnant, actively trying to conceive, or just thinking about your options, this guide will help break it all down in clear, friendly terms, so you feel empowered to make confident choices.

Can I have a baby if I have lupus?

Yes, people with lupus can have babies. While lupus is a chronic autoimmune disease — meaning the immune system attacks the body’s own tissues — many individuals with lupus go on to have successful pregnancies.

The key? Planning and timing. Experts recommend trying to conceive only when lupus has been stable (or “quiet”) for at least six months. That’s because active disease during pregnancy can increase the risk of complications like preeclampsia (a dangerous blood pressure condition), premature birth, and miscarriage.

So, if you’re thinking about pregnancy, the first step is setting up a preconception appointment with your rheumatologist and obstetrician (ideally one experienced in high-risk pregnancies). Together, they can review your health, medications, and fertility plan to set you up for the safest, healthiest experience possible.

Is it hard to get pregnant if you have lupus?

Fertility rates in people with lupus are generally similar to those without the condition — unless lupus is active or complications like kidney disease or antiphospholipid syndrome (APS) are involved. APS is a blood clotting disorder often seen alongside lupus that can raise the risk of recurrent miscarriage or fertility struggles.

Another consideration is medication. Some lupus treatments, like the chemotherapy drug cyclophosphamide, can affect ovarian reserve (the number and quality of eggs) and may reduce fertility, especially with long-term use. If you’re concerned, your doctor might recommend checking your ovarian reserve through blood tests like AMH (anti-Müllerian hormone) or discussing options like egg freezing.

Are people with lupus more likely to miscarry?

Unfortunately, yes — people with lupus have a higher risk of miscarriage compared to the general population. This is mostly due to overactive B cells, which produce autoantibodies (like ANAs and anti-dsDNA) that can harm pregnancy. Rising estrogen levels during pregnancy can worsen this, increasing inflammation and lupus activity.

The risk is especially high if lupus is active or if conditions like antiphospholipid syndrome (APS) are present. But here’s the key: when lupus is well-controlled before conception, many people go on to have healthy pregnancies. Regular monitoring and expert care make a big difference in lowering risks.

Is lupus considered high risk pregnancy?

Yes — lupus pregnancies are generally classified as “high risk,” but that doesn’t mean disaster is inevitable. It just means you’ll need a little extra love and attention from your care team.

This usually involves more frequent prenatal visits with specialized ultrasounds to monitor the baby’s growth, close tracking of your kidney function, blood pressure, and lupus activity, and coordination between your rheumatologist, obstetrician, and sometimes a maternal-fetal medicine (MFM) specialist (these doctors handle high-risk pregnancies).

With a good support team and a proactive care plan, many people with lupus deliver healthy babies and recover well postpartum.

Can you pass lupus on to your child?

Lupus is not directly inherited like a single-gene disorder, but genetics does play a role. Children of parents with lupus have a slightly higher risk of developing lupus or another autoimmune condition later in life, but the overall risk is still low.

More importantly, certain maternal antibodies (like anti-Ro/SSA and anti-La/SSB) can cross the placenta and affect the baby, potentially causing neonatal lupus. This rare condition can lead to a temporary rash or, more seriously, a heart block (a type of heart rhythm problem). To prevent or manage this, doctors will carefully monitor the pregnancy and may recommend specific medications or interventions if needed.

Is it safe to take lupus medication while pregnant?

In most cases, yes — but it depends on the medication. Some drugs, like hydroxychloroquine (Plaquenil), azathioprine, tacrolimus, and cyclosporine, can be continued and even help reduce complications. Others, like methotrexate, mycophenolate mofetil, leflunomide, and cyclophosphamide, need to be stopped well before pregnancy because they can harm a developing baby.

Never stop or change your medications without medical guidance — uncontrolled lupus can be much more dangerous to both you and the baby than most medications.

What else should you know when planning pregnancy with lupus?

Planning ahead is essential when you’re managing lupus and pregnancy. Ideally, you want your lupus to be stable for at least six months before trying to conceive — active disease at conception raises the risk of flares, pregnancy loss, preeclampsia, and early delivery.

Low-dose aspirin (81 mg) is usually recommended starting in the first trimester to lower the risk of preeclampsia. If you have antiphospholipid antibodies or antiphospholipid syndrome (APS), you might also need blood thinners like heparin during pregnancy and after birth.

For those with anti-Ro/SSA or anti-La/SSB antibodies, your baby may need special heart monitoring during pregnancy to check for rare complications like congenital heart block.

Throughout pregnancy, you’ll work closely with a team — usually including your rheumatologist, a high-risk OB, and sometimes a nephrologist or pediatric cardiologist — to monitor your health and your baby’s growth. After delivery, lupus flares are more common, so make sure you have a postpartum care plan with your rheumatologist and OB. Staying on top of appointments, labs, and medication plans is key to keeping both you and your baby safe.

Talk openly with your doctors, advocate for your needs, and know that many people with lupus go on to have beautiful, healthy pregnancies and families.

Tassia O'Callaghan is an experienced content writer and strategist, having written about a vast range of topics from chemical regulations to parenting, for brands like Peanut App Ltd, Scary Mommy, Tally Workspace, and Fertility Mapper. She's an advocate for realistic sustainable living, supporting small businesses (author of A-Z of Marketing for Small Businesses), and equity across all walks of life. Follow her on LinkedIn or TikTok, or see more of her work on Authory or her website.