Understandably, the best time to attempt pregnancy is when your disease is stable and you are not experiencing a flare, experts say. For most women with lupus, getting pregnant is no more difficult than it is for other women. When infertility is an issue, medications for lupus – rather than lupus itself – are likely to be responsible. The biggest offender is cyclophosphamide (Cytoxan), an immunosuppressive drug given for severe autoimmune disease, including lupus complicated by severe nervous system disease or kidney disease. “If a woman is over 30, she has about a two-thirds chance of infertility if treated with Cytoxan,” says Michelle Petri, MD, professor in the division of rheumatology at Johns Hopkins University in Baltimore and co-director of the Hopkins Lupus Pregnancy Center. The reason is that Cytoxan can cause premature ovarian failure, which renders a woman irreversibly infertile. However, research shows that the hormonal drug leuprolide (Lupron) may help reduce the risk of sterility in women taking Cytoxan.

Although most other drugs don’t have severe effects on fertility, some can affect an unborn child from the very earliest days of pregnancy. Because the effects of certain drugs can remain in the body for a period of time after you stop taking them, ideally, you should work with your doctor to taper off harmful medications – and perhaps switch to less risky medications (SeeArthritis Medications in Pregnancy: What’s Safe, What’s Not”) – for at least a few months before you try conceive.

Before you get pregnant is also the best time to speak to your doctor about prenatal vitamins and supplements of folic acid, which can help reduce the risk of certain birth defects. Your doctor may also recommend a calcium and vitamin D supplement, but will probably advise that you avoid any over-the-counter herbal remedies.

First Trimester

Drugs continue to be a concern in the first trimester and throughout pregnancy. If you didn’t discuss medications with your doctor before you got pregnant, now is the time, says Dr. Petri.

Some drugs, such as cyclophosphamide, can cause birth defects. Others, such as methotrexate, can cause miscarriages. If you’re taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, your doctor may let you continue to using them – at least for a while. The greatest risk of these drugs comes later in pregnancy, when they may interfere with labor, affect amniotic fluid production or cause excessive bleeding during delivery. If you need medications to keep your disease under control, your doctor may put you on a corticosteroid, such as prednisone, that reduces arthritis inflammation but crosses through the placenta only minimally. If experience morning sickness with frequent vomiting during the first trimester, let your doctor know, as this may interfere with your body’s absorption of medications you need.

From now until the end of your pregnancy, there’s a possibility that your disease may flare or become more active, although research results have been inconsistent on just how great that possibility is.

Whether pregnancy affects your lupus or not, there is a chance that lupus may affect your pregnancy – particularly if you have antiphospholipid antibodies. These antibodies, which are present in as many as 30 percent of people with lupus and a much smaller percentage of otherwise healthy people, can cause blood clots in the placenta that can lead to miscarriage. In fact, they may be responsible for as many as 10 percent of all miscarriages. “Although antiphospholipid antibodies are usually associated with pregnancy loss in the second or third trimester, there is a subset of women who have very early loss from antiphospholipid antibodies,” says Dr. Petri.