The Second Trimester of Being Pregnant with Lupus.

It turned out to be true for me that the second trimester was the sweet spot of pregnancy.  A lot of my first trimester symptoms faded or disappeared entirely and I didn’t experience many new or intense pregnancy woes until the second trimester was nearing its end.  Being pregnant with lupus meant that it wasn’t completely smooth sailing, of course.  I had more doctor’s appointments, medications, and potential complications compared to the average pregnant woman, and I’ll share them all here along with a few cute photos and the gender reveal.

 

The Second Trimester of Being Pregnant with Lupus.

November 11, 2017 – February 24th, 2018

 

 

Medical care in the second trimester.

I saw my regular OBs (I rotate through a team of 10 doctors) for routine visits on weeks 15, 20, 24, and 27.  At the week 15 appointment I was advised to start taking medication for my intense heartburn, which has been immensely helpful.  The second part of my sequential screening (which checks for fetal defects and abnormalities) was completed at the week 20 appointment and turned out to be normal.  At week 24 I had to ask my OB for prednisone because my lupus was flaring and my rheumatologist wouldn’t prescribe it to me (despite the fact that it is safe and recommended by the maternal fetal medicine doctor).  Week 27 revealed mild anemia so I began taking a ferrous sulfate supplement.  I also completed my gestational diabetes screening at that appointment, which was negative, and the sweet drink really wasn’t as bad as it is often made out to be.

I saw my maternal fetal medicine (MFM) doctor for ultrasounds on week 18 and 24.  We were fortunate to be able to find out the sex of the baby at week 18!  The day after that appointment we left for our anniversary trip to a luxury yurt in Virginia and really savored being the only ones who knew during our short vacation.  We told our respective families right after the trip on Christmas Eve and Christmas Day – it was fun timing!  Trying not to use a pronoun was really difficult once we knew which one to use, but we did manage to make it to the reveals without spilling the beans.

We told my family by having each person put a boy’s name and a girl’s name in separate bowls and then choosing the bowl for what we were having and reading the names – it was simple and a good way to get ideas for names.  We told Mr. Meena’s family by adding some food coloring to the cake we were making for Christmas dinner.

 

 

Yes, blue is for boy!  We were so excited to find out we’re expecting a boy.  The week 18 ultrasound was also fun because our boy showed off some ninja moves for us!  He was very active throughout the appointment and actually managed to put his feet above his head at one point.  We all had a good laugh thanks to his antics.

 

 

Being pregnant with lupus means I had to juggle caring for myself, my baby, and managing my chronic illness.  I saw my OBs, MFM doctor, and rheumatologist frequently throughout the second trimester.  However, after my rheumatologist refused to prescribe me prednisone around week 24 I decided to renew my efforts to find a new one (I had been searching for a new one for almost a year).  I was finally able to find a new rheumatologist and visited her on week 27.  Being pregnant with lupus requires a higher level of care and my new rheumatologist is better equipped to provide that, especially because she’s treated many women with lupus during their pregnancies.  I really encourage anyone with an autoimmune disease to have a top notch rheumy before trying to conceive.

Mr. Meena had an important doctor’s appointment during the second trimester as well; he saw our primary doctor to get his Tdap vaccine.  The CDC recommends that anyone who will care for a baby in their first two to three months receive the Tdap vaccine in order to protect against tetanus, diphtheria, and pertussis (whooping cough).  We are being a very overprotective in this area (partially because of my immunosuppressant medication) and insisting that all visitors wanting to see our baby before he is three months old receive the Tdap if they haven’t had one recently.

Lastly, I enrolled in the maternity support program offered by my insurance company towards the end of the second trimester of being pregnant with lupus.  It started with a phone call from a registered nurse where we went over my medical history, questions, and concerns.  It also gave me access to their resource library.  I’ll be chatting with the same nurse throughout the rest of my pregnancy and she’ll also be helping me to order a breast pump through my insurance.  I definitely recommend checking to see what maternity services like this one are included in your insurance plan.

 

Second trimester pregnancy symptoms.

Nausea: I still had pretty severe nausea for the first two weeks of the second trimester.  This made me quite nervous; I was concerned that I’d be one of those pregnant women who experienced nausea throughout the entire pregnancy.  Fortunately the queasiness tapered off quickly, showing up once or twice a week through week 18 and then disappearing almost entirely.

Appetite: I started being hungry all the time on week 17, so it’s really good that the nausea was pretty much gone by then!  It was actually quite difficult to get enough to eat and eating did start to feel like a chore at times.  It was also hard for me to get the suggested 70 grams of protein every day so I started making shakes using my husband’s protein powder.

Cravings: I didn’t really have any of the stereotypically strange or intense pregnancy cravings.  I craved the things that I normally crave when I’m tired or hormonal, and there was only one time that I felt like I had to have something immediately.  Unfortunately, that something was BBQ Fritos which are no longer available in my local stores!

My bump: I felt like I didn’t show at all until week 17, and even then it was hit or miss whether it was a baby or an extra layer of fat (or both).  In my opinion, I didn’t start looking pregnant consistently until about week 26.  In fact, I didn’t have someone randomly ask if I was pregnant until I was 31 weeks along.  It’s possible that I haven’t had much of a bump because I’m a larger person – almost 5’9” and between 190-200 lbs. in the second trimester.

Here’s what my bump looked like at 20 weeks.

 

 

Nasal congestion: This is one of those pregnancy symptoms that I didn’t know about until it happened to me.  My nose started running constantly in the second trimester, with more blood that usual, and required regular clearing.  I began carrying tissues with me everywhere.  There’s actually a term for this – pregnancy rhinitis – and it usually happens when your nasal passages swell from excess estrogen or the blood vessels in your nose swell because of your blood volume increase during pregnancy.

Abdominal pains: These continued from the first trimester and often felt like growing pains.  There were some occasions where I had sharp pains though – usually when I was getting up or turning over in bed.  After about 26 weeks the abdominal pain started to feel a bit like cramping or super achy, overstretched muscles.

Sleeping: I was getting a full night’s sleep without too much pain for most of this trimester, thank goodness!  I started using a Boppy side sleeper pregnancy pillow on week 18 to prevent me from sleeping on my back.  (If you’re looking, the Boppy is a good maternity pillow – especially if you want to continue using your regular neck pillow and not monopolize the whole bed.  It’s just two wedge pillows attached with a cover, although the cover isn’t very well made and the seams in my cover popped during the first week of use.)

Fetal movement: I started feeling some fluttering sensations on week 16, and some stronger but still vague movements by week 18.  The first time I was sure I felt the baby move distinctly was week 20.  These movements were hard to wait for and treasured… until about week 25 when they started to get painful.  My little man became very active and kicked me and Mr. Meena (whenever he was close enough to be kicked) quite frequently.

I made the mistake of asking Google if the baby could actually cause damage and that’s when I learned that babies in-utero can break ribs and tear muscles, among other undesirable things.  In fact, their kicks can pack up to 6.5 lbs. of force at 20 weeks gestation and up to 10.5 lbs. of force at 30 weeks!

I have enjoyed the fetal movement very much, often telling friends and family that he’s throwing a party or that there’s an earthquake in my abdomen.  When he seems to be getting especially violent, however, I tend to walk around or rock back and forth in the hopes that he’ll go to sleep.  By the end of the second trimester I was very ready for him to have a bit less space so that his punches and kicks would be less powerful.

 

Me at 25 weeks at Campbell’s Covered Bridge in South Carolina.

 

Muscle cramps: I started experiencing muscle cramps around 22 weeks.  I felt like I was one big cramp waiting to happen – every time I stretched or turned a certain way one of my muscles would threaten to cramp (and it usually did make good on that threat).  I woke up at night several times with Charlie horses and foot cramps.

Sciatica pain: I wasn’t really familiar with sciatica pain before pregnancy but now that I am I have such deep empathy for people who have it regularly.  My pain would go from my lower back, through my tailbone, and down into my legs.  It started around week 24 and prevented me from being able to sit up for several days at a time.  It wasn’t consistent, perhaps sometimes the baby would press on the sciatic nerve and make it worse, but when it did happen it took forever to find relief.  I would have to lie down or use a heating pad for hours before the pain would lessen significantly.  And since I couldn’t sit due to sciatic pain or lie on my back because of my growing bump, my comfortable positions were quite limited.

 

Second trimester lupus activity.

In my first trimester post I mentioned that I stopped several of my lupus medications for five weeks until I was able to see the MFM doctor on week 13, when I was cleared to start taking them again.  Going off several medications suddenly was tough (and certainly ill-advised) and it took a long time for me to recover after restarting them.  I experienced a lot of lupus symptoms while my immunosuppressant was building back up in my system but felt bad enough that on week 25 my rheumatologist increased the dosage.  It took another two to four weeks to start feeling the results of the higher dosage but eventually my lupus symptoms tapered off to an almost manageable level.

Many women with autoimmune diseases experience some level of suppression during pregnancy since being pregnant naturally lowers the activity of the immune system (to prevent the mother’s body from attacking the fetus).  This seems to be quite common for women with rheumatoid arthritis, but the jury is still out on whether or not women with lupus are prone to remission during pregnancy.  In fact, most of what I’ve read on the topic indicates that being pregnant with lupus makes you more likely to have flares, especially if the disease wasn’t under control for six months prior to conception (which mine wasn’t).  This is part of the reason why it’s important to treat lupus aggressively and appropriately during pregnancy.

Even though my lupus is not technically active – according to my lab tests – I had many lupus symptoms and side effects throughout the second trimester.  I suffered varying cognitive impairments (headaches, confusion, memory loss) as well as pain, stiffness, and swelling in several of my joints (although some of the swelling was probably related to being pregnant).  I felt fatigued and continued to have extreme photosensitivity.  Most days I had a malar rash (a red, butterfly shaped rash across the face) as well as rashes on my neck, back, and knees (that was a new spot for me).  I also experienced lupus related chest pain (known as pleurisy) although I couldn’t help but wonder if it was due to my rib cage expanding during pregnancy.  And, as always, I had a great deal of muscle pain on most days.

In the end I had to go through two rounds of prednisone during my second trimester and I probably would have gone through four or five rounds if my previous rheumatologist had been willing to prescribe it to me.  My new rheumatologist and my MFM doctor both want me to take chronic low dose prednisone throughout the rest of the pregnancy but I declined.  Most of my lupus symptoms cause me discomfort and inconvenience but they haven’t impacted my baby or actually caused damage to any organs at this point, so I was not yet willing to suffer the side effects of long-term prednisone use just to ease my own discomfort.  This may change in the third trimester, of course.

 

Me with those trees I love SO MUCH – celebrating the beginning of my third trimester (about a week ago). Hope my boy doesn’t mind pink. 😂 🌸 . . . #lupuspregnancy #highriskpregnancy #preggo #thirdtrimester #pregnancyjourney #pregnancyphotos #expectingmama #weloveclt #exploreclt #ewpclt #charlottesgotalot #ig_charlotte #queencityscenes #charlottelife #mycharlotte #visitnc #flowerstagram #cherrytree

A post shared by Ava Meena (@mymeenalife) on Mar 4, 2018 at 11:44am PST

I was really happy on the day the above photo was taken, because I had made it to 28 weeks and my baby would have a good chance of being okay if he decide to arrive early for any reason.  It was a huge relief to make it that far and every day afterwards has made me feel a bit more confident that I can have a healthy delivery and baby.

I expected that I would be somewhat more prepared than the average person for the aches and pains of pregnancy since I’ve suffered from chronic pain for several years, but so far that doesn’t seem to be the case.  Adding pregnancy pain on top of lupus pain has made me feel a bit out of control – there are just so many body parts that are affected.  On any given day, my fingers would hurt to the point that I couldn’t use them (lupus), my sciatica nerve would keep me from sitting or bending over (pregnancy), my knees would be too stiff to bend (lupus), the baby would kick and nearly bring me to tears (pregnancy), my rashes would burn and itch (lupus), and my legs would cramp up over and over again (pregnancy).  It definitely started to feel like too much to handle.

What I learned from the second trimester is that being pregnant with lupus requires a great deal of strength, a wonderful support system, so much rest, and very capable, understanding doctors.

 

Planning for baby.

As you might imagine, the issues created by lupus and pregnancy made it difficult to plan for baby’s arrival throughout the second trimester.  We tried our best to research what we needed and figure out which products and brands best suited us but it was a struggle.  We were short on time and money, due to medical expenses and also because we purchased a house last November that has required lots of improvement and maintenance.

It’s also difficult because of my medical appointment frequency and insurance expenses.  We managed to put together a small registry (about 30 items) of things we wanted and needed for baby but we didn’t actually have a single thing for him in our home at the end of the second trimester! (With the exception of samples that arrived in our Amazon baby registry welcome box.)  I was definitely starting to feel a little panicked.  Even though we’ve embraced minimalism and don’t want to have a lot of physical items for the baby, there is still just so much to prepare before he comes home with us.  We did take a baby financial class at the end of the 27^th week, sign up for two more classes plus a hospital tour, create pre-birth to-do lists, and start looking for our pediatrician – which made me feel a bit more accomplished.

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Thanks for reading all about what it was like for me to be pregnant with lupus in the second trimester.

Next up: read about my third trimester.

Have questions, comments, or a story to share?  Drop in the comment section below!

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