1. Pay attention to ovarian function protection and use ovarian toxic drugs with caution.
Cyclophosphamide (CTX) and regimen preparations are commonly used in the treatment of SLE, with positive efficacy. However, both have a prominent toxic reaction to the gonads, and it is not uncommon for them to lead to ovarian failure clinically. Once amenorrhea occurs, even if the drug is discontinued in time, some patients are unable to resume menstruation.
Therefore, patients with SLE who plan to have a pregnancy should use CTX and Radix et Rhizoma with clinical caution, pay attention to menstrual changes when applying them, regularly check sex hormone levels, detect abnormal changes, and promptly adjust treatment to avoid irreversible ovarian failure.
2. Master the timing of pregnancy.
Pregnancy and childbirth used to be contraindicated in SLE patients because they often lead to recurrence or aggravation of SLE and even endanger life. The timing of pregnancy in SLE patients mainly depends on the activity of SLE, but after the disease is controlled, pregnancy can be planned and most of them can safely pass the pregnancy and childbirth period.
However, pregnancy is contraindicated in patients with heart, lung, kidney and central nervous system lesions. SLE is more likely to recur when the patient starts pregnancy than when the disease is stable. It is generally recommended that pregnancy can be considered when there is no significant organ involvement, the disease has been stable for more than one year, the dosage of prednisone is less than 10 mg daily, and immunosuppressive drugs (such as CTX, methotrexate, and raltegravir) are stopped for more than six months. If you have antiphospholipid antibodies, it is best to wait for more than 3 months for antiphospholipid antibodies to turn negative before getting pregnant to reduce the occurrence of miscarriage.
3, close monitoring, appropriate use of drugs.
During pregnancy, it is necessary for SLE patients to be followed up by the rheumatology and obstetrics departments to avoid overwork or infection. If the condition is unstable, prednisone treatment can be applied. Prednisone is inactivated when it passes through the placental barrier and has no significant effect on fetal development as long as the dose is below 30 mg/d. Dexamethasone, on the other hand, can directly affect the fetus through the placental barrier, so it should not be used in patients with SLE during pregnancy.
SLE patients with recurrent miscarriage are often associated with positive antiphospholipid antibodies and require additional low-dose aspirin therapy. Antimalarials can accumulate in the infant’s retina and should therefore be discontinued before conception. The effects of azathioprine and cyclosporine on the fetus are not well documented in large samples. If CTX or methotrexate has to be used for severe disease, pregnancy should be terminated for the safety of the mother and to avoid the development of malformations.
The possibility of pregnancy in patients with lupus erythematosus is controversial because of the tendency to miscarriage in the first trimester and the ability to cause exacerbation in the last trimester and postpartum. In clinical practice, it has been observed that most female patients get married, get pregnant and give birth based on the basic remission of the disease. The disease is still in remission after childbirth, but certain conditions must be present.
Such as.
(1) The disease has been in basic remission for more than 6 months.
(2) Negative for anti-cardiolipin antibodies. Positive individuals are prone to miscarriage and stillbirth.
(3) Prednisone should be taken in maintenance doses of less than 15 mg or without hormones.
(4) The pregnancy should be followed up regularly under the observation of a specialist and delivered in an experienced hospital obstetrics department.
(5) The fetus is protected by the placenta’s ability to oxidize prednisone to the inactive 11-ketone form. Therefore, prednisone administration by the mother has no effect on the fetus. To prevent deterioration of the disease during pregnancy and postpartum, the dose should be increased depending on the disease. The original dose can be resumed in stable cases.
(6) Dexamethasone and betamethasone cannot be oxidized by placental enzymes and can affect the fetus, so patients taking these hormones should be replaced with prednisone.
(7) More calcium should be added during pregnancy and lactation, otherwise it will accelerate the patient’s osteonecrosis.
(8) The dose of prednisone during lactation should be under 15 mg per day and not more than 30 mg per day.
(9) Salicylates, non-steroidal anti-inflammatory drugs, and antimalarials are contraindicated in pregnant women. Immunosuppressants should also be discontinued.
With the improvement of the diagnosis and treatment of SLE, the goal of SLE treatment is not only to prolong life but also to maintain long-term remission and improve quality of life. The relationship between pregnancy, childbirth and SLE is an issue of concern because SLE predominates in women of childbearing age.