Pregnancy in women who suffer from SLE and Lupus nephritis

  • Systemic lupus erythematosus (SLE) is an autoimmune disease which predominantly affects women of childbearing age. Pregnant women with SLE have a higher risk of pregnancy complications than those without SLE.

    • I have SLE. Do I have to "plan" my pregnancy?
    • The ideal condition for the onset of pregnancy is that the disease is in full recession for 6 months. Active SLE at the time of conception is known to be the strongest predictor of adverse pregnancy outcomes.
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    • What should I do before getting pregnant?
    •  It is extremely important to make an assessment by the rheumatologist and nephrologist to:
    • • Assess whether the pregnancy will pose risks to the mother, the fetus, and the kidney function in general at that time.
    • • Take the necessary actions for optimal disease remission.
    • • Proceed to the necessary medication modifications to ensure the safety of the pregnancy.
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    • Should I do some extra laboratory testing?
    • Yes, the level of renal function (creatinine) should be examined and general urine tests should be performed, urine albumin (protein), uric acid as well as some SLE-specific tests, such as IgG and / or Ig IgG anti-phospholipid antibodies (aPLs), but also auto-antibodies (anti-dsDNA, anti-Ro / SSa, anti-La / SSB etc) that the nephrologist will recommend.
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    • Should I change something in my pre-pregnancy medication?
    • This should be done after the examination by the rheumatologist and the nephrologist. Some modifications to the treatment must be made by ceasing the intake of some medicines that are not safe for the pregnancy (eg cyclophosphamide is forbidden) by replacing them with safer ones. For example, hydroxychloroquine (eg Plaquenil) can be continued during pregnancy (always when recommended by the rheumatologist / nephrologist's advice). Corticosteroids can be used in a pregnancy and azathioprine is still considered safe. Medicines that may be discontinued (before conception) are some antihypertensives that convert enzyme inhibitors and angiotensin II. There are safe medicines to regulate the hypertension that their intake is recommended instead.
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    • What complications can occur due to SLE during pregnancy?
    • Too many pregnancies in women with SLE had no complications. However, a SLE pregnancy is always considered "higher risk" than a pregnancy "without SLE". This happens since a pregnancy with SLE has a slightly higher percentage of pregnancy complications "without SLE". The most common complication is premature labor. Moreover, preeclampsia occurs more often in a pregnancy of a woman suffering from SLE than than "without SLE". However, SLE does not appear to be linked to other complications directly related to the fetus.
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    • Can I get pregnant when the lupus nephritis is on the rise?
    • It will be much better if not, it is much safer for a woman who wants to get pregnant to wait until the disease is in recession for more than 6 months (after consultation with the treating nephrologist). To assess if SLE nephritis is active, the level of albumin in urine and the renal function, the blood pressure, and microscopic examination of urinalysis should be examined.
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    • How should my pregnancy be monitored since I have lupus nephritis?
    • There should be a close cooperation between the gynecologist, the nephrologist and the rheumatologist. This will promote a healthy pregnancy. As prementioned, a follow-up plan must be followed that includes the control of the blood pressure, the kidney function, and albuminuria (proteinuria) level.
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    • Is breastfeeding is allowed when I suffer from SLE / lupus nephritis?
    • Yes, it is. Many drugs are safe for breastfeeding (eg prednisolone, hydroxychloroquine, azathioprine) while others are forbidden (cyclophosphamide).
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      • Mesogeios Dialysis Centers Group Scientific Team
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      • Bibliography 
      • 1.Systemic Lupus Erythematosus and Pregnancy , Updated: Jan 10, 2017 Author: Ritu Khurana, MD; Chief Editor: Christine Isaacs, Medscape Nephrology
      • 2.Kattah AG, Garovic VD. Pregnancy and Lupus Nephritis. Semin Nephrol. 2015 Sep;35(5):487-99. doi: 10.1016/j.semnephrol.2015.08.010. Review.
      • 3.Buyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, Sammaritano L,Branch DW, Porter TF, Sawitzke A, Merrill JT, Stephenson MD, Cohn E, Garabet L,Salmon JE. Predictors of Pregnancy Outcomes in Patients With Lupus: A Cohort Study. Ann Intern Med. 2015 Aug 4;163(3):153-63. doi: 10.7326/M14-2235.
      • 4.Yang MJ, Chen CY, Chang WH, Tseng JY, Yeh CC. Pregnancy outcome of systemic lupus erythematosus in relation to lupus activity before and during pregnancy. J Chin Med Assoc. 2015 Apr;78(4):235-40.
      • 5.Singh AG, Chowdhary VR. Pregnancy-related issues in women with systemic lupus erythematosus. Int J Rheum Dis. 2015 Feb;18(2):172-81.
      • 6.Koh JH, Ko HS, Kwok SK, Ju JH, Park SH. Hydroxychloroquine and pregnancy on lupus flares in Korean patients with systemic lupus erythematosus. Lupus. 2015 Feb;24(2):210-7. doi: 10.1177/0961203314555352. Epub 2014 Oct 10.
      • 7.Peart E, Clowse ME. Systemic lupus erythematosus and pregnancy outcomes: an update and review of the literature. Curr Opin Rheumatol. 2014 Mar;26(2):118-23.
      • 8.Lateef A, Petri M. Managing lupus patients during pregnancy. Best Pract Res Clin Rheumatol. 2013 Jun;27(3):435-47. doi: 10.1016/j.berh.2013.07.005. Review.
      • 9.Ostensen M, Clowse M.Pathogenesis of pregnancy complications in systemic lupus erythematosus.Curr Opin Rheumatol.2013 Sep;25(5):591-6.
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