SLE and Pregnancy

Question 1

Standard of care in pregnant patients with SLE

Answer 1

HCQ

Question 2

Benefits of HCQ in pregnancy

Answer 2

Not associated with congenital malformations

Question 3

D/C’ing HCQ during pregnancy can do what?

Answer 3

Increase risk of flare, increased morbidity and mortality for the fetus

Question 4

NSAIDs in SLE for pregnant patients

Answer 4

Generally avoid, especially in the third trimester

Question 5

How to manage pain in SLE during pregnancy

Answer 5

APAP

Question 6

Steroids in SLE for pregnancy

Answer 6

Use PO steroids PRN for inflammatory manifestations
Use low potency steroids topically because they won’t reach the blood stream

Question 7

LN care in pregnancy: what to use in mild disease activity

Answer 7

HCQ/AZA

Question 8

LN care in pregnancy: what to use in clinically active LN

Answer 8

Non-fluroinated PO glucocorticoid
AZA if necessary to control LN to reduce steroid dose
Preterm delivery considered if highly active

Question 9

SLE drugs that are teratogenic

Answer 9

MMF, CYC, MTX