5 Tips to Manage Lupus During Your Twin Pregnancy

non-stress test

The journey to parenthood varies for everyone. In the process, it creates a bond among families no matter how they became parents, whether this is the first or their last child, or whether the pregnancy was uneventful or full of challenges. Alex began her path to parenthood several years before she had her family. After years of pain and discomfort she finally discovered she had an autoimmune disease, Lupus, that can be managed and monitored while still being able to have children. Now a mom to a three-and-a-half-year-old daughter and a one-and-a-half-year-old son, Alex and her husband were surprised to discover they would now be adding dichorionic diamniotic (di/di) twin girls.


For years Alex had various symptoms which seemed to center around stomach pain. After two years, she had diagnostic surgery for endometriosis. The blood test prior to the surgery showed inflammatory markers in the high range, however, the surgery tested negative for endometriosis. Although she was happy with the negative test results she endured two more years of seeing specialists including gastroenterologists, urologist, and gynecologists before she finally figured out what was causing all her symptoms.


In 2010 Alex began experiencing severe joint pain all over her body making her feel like she was hit by a bus. When she could barely walk, her physician recommended a rheumatologist who months later finally diagnosed Alex with Systemic Lupus Erythematosus (SLE or Lupus). The immune system is part of the body that fights off viruses, bacteria, and germs. With Lupus, something goes wrong with the immune system. Normally the immune systems produce proteins, also referred to as antibodies that protect the body from these invaders. Autoimmunity means your immune system can’t tell the difference between foreign invaders and your body’s healthy tissues. The Lupus Foundation of America defines Lupus as a chronic autoimmune disease that can damage any part of the body. The Foundation further defines chronic as signs and symptoms that tend to last longer than six weeks and often lasts for many years. Some common Lupus symptoms include extreme fatigue that doesn’t go away with rest, joint pain, fever, and muscle pain.



The diagnosis was bitter sweet because she finally discovered the source of all her medical issues, however, she wondered how Lupus could affect her ability to get pregnant. Alex wanted to have children someday so she was happy to learn that for most women with Lupus a successful pregnancy is possible. While there are risks of pregnancy in Lupus patients, less than 50% of pregnancies in women with Lupus have complications. All Lupus pregnancies are considered high-risk especially when you are carrying multiples. It isn’t always easy to plan a pregnancy, but Alex had no trouble getting pregnant with her first two babies which were well thought out and planned. She talked with her rheumatologist before each pregnancy who monitored her closely. Alex takes a low dose of Plaquenil which is a drug that is used to treat auto immune diseases and malarial infections. Since Alex has taken this drug long term with a pretty low dose, it is safe to use while expecting and she helps keep her Lupus from flaring up.

Her twin pregnancy

Her twin pregnancy is different than it was when she was pregnant with her first two children. During her first two pregnancies Alex experienced some lower abdominal cramping that sent her to the hospital for a few nights to monitor signs of preterm labor at 26 weeks. With this pregnancy Alex has experienced some of the same pain for a few days sporadically, but she puts herself on bed rest which seems to help a lot. She hasn’t had to be hospitalized and is almost 24 weeks along. Her advice to other twin moms with Lupus is to listen to your body. If you’re feeling overwhelmed take a rest. Surround yourself with supportive people including your partner, family, friends, neighbors – anyone who is willing to help let them help. This has been a tough pill for Alex to swallow since she likes to do everything herself. But by letting others help you it helps you have a better pregnancy.

Here are 5 tips that Alex would give another expectant MoM to manage Lupus during her twin pregnancy:

1. Keep stress to a minimum
Stress feeds inflammation and can quickly cause a flare-up which can land you on bed rest pretty quickly. During my first singleton pregnancy, I made it to 26 weeks before the sudden-onset of lower abdominal pain, inflammation, and lower back pain caused by job stress sent me to the hospital. I tested positive for possible pre-term labor, so I was kept for 3 nights for close monitoring before they sent me home to be on modified bed rest. I had to go on sick leave from my teaching job and take it easy at home for the next 14 weeks until my baby girl was born at term. With my second born, I was careful to not let stress creep up on me like it did with my first. With my twin-pregnancy, so far, I have already had stress-induced inflammation twice! I’m having a hard time keeping my stress levels low. I have learned that when hit with an inflammation flare-up, I take about 5 days of rest with my feet up, and I’m back to “normal.”
2. Listen to your rheumatologist
Just like pregnancy, Lupus looks different for everyone. This means that the treatment prescribed by rheumatologists will be different for everyone too. There are some medications that you can’t take during pregnancy and some that you can. Lucky for me, I am allowed to continue taking a low dose of Plaquenil daily, and I find this keeps me on track (for the most part). I’ve found that if I forget to take my medication for even one day, I feel awful all over by the next. As pregnancy (and especially a twin pregnancy) already has us feeling not 100%, this is not something I want to deal with! On top of the medication, make sure that you continue to have regular blood work done with your rheumatologist so that he or she can monitor you. If things take a turn for the worst, you have a good baseline.
3. Stay (moderately) active
This is difficult to do, especially when you’re carrying two and have other children at home, but if you can find 15 minutes a day to do some sort of low-impact activity, you will reap huge benefits! Going for a walk, practicing yoga or pilates, meditation, and doing light stretching have all helped me increase my energy levels and just feel happier! Of course if you’ve been working out strong for your entire pregnancy, you can continue that, as long as you’re given the green light by your doctor. For me, being more inactive than active, I would say that these light activities have helped me (and my joints) stay “loose” throughout my twin pregnancy.
4. Eat right
Again, this is easier said than done when you may have pregnancy related food aversions, morning sickness, and other picky children to feed. However, I found that having a strict diet low in animal fat, processed foods, gluten, dairy and sugar, allowed me to 1) put my Lupus into remission when I was first diagnosed, 2) get pregnant with my first born, and 3) keep my main Lupus symptoms, such as joint pain, in check with my twin pregnancy. Even eating lean chicken breast and fish, along with grains and green veggies has kept me on track this pregnancy with much more energy (at least through my second trimester) than I originally anticipated.
5. You can never have too much sleep
Sleep (and rest) is GOLD! If you have an incredible partner like I do, or family/friend help in any way, who is comfortable telling you to “just go lay down” or “go have a nap…you need it,” then TAKE IT! I am a pretty strong-willed person, myself, so when I see something that I think needs to be done (and I don’t want it added to the long list of things my husband is taking on), I just do it. But I recognize that I’m very fortunate because if I’m caught, I get “the look” and I know it’s time to go lay down. It happens just as frequently when my mom and sister are over and telling me to “go sit down” and I direct them at setting up the nursery, doing laundry, or any other chore that needs doing.
Long story short, rest is vital in a twin pregnancy, and if you have help with other things around the house, then it is your duty to just lay down and cook your babies. If you don’t have the help, put aside an equal amount of time to rest as you do looking after the house and/or your other children. There’s no shame putting on a show or video for your little(s) when you are feeling exhausted. You NEED to take care of yourself and your twin babies, or else just like stress, a lack of sleep can cause inflammation and subsequent joint pain, possibly sending you into a full-blown flare-up and doctor-ordered bed rest. So just do the bed rest on your own from the beginning, and you should be fine!


Diana Coleman is a native Austinite and works in the wholesale electricity market as a market specialist. She is a married mom to 2.5 year old boy/girl twins Chloe and Greyson. She enjoys organizing, reading, and watching movies while secretly fears potty training and getting her little ones to sleep in separate rooms.



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