SLE is commonly seen in women of childbearing age, and for these patients marriage and childbirth is a major life event. The following is a list of considerations for lupus patients during pregnancy preparation, pregnancy and breastfeeding. The best time for a patient to get married is when the disease is stable and there is no serious damage to internal organs. Patients with lupus who already have children or whose disease is active should strictly use contraception, and should not apply contraceptives containing estrogen or mixed preparations of estrogen and progestin. Condoms. (1) In the first 2 years of lupus; (2) In those whose disease is not yet under control (using large amounts of hormones) or who have not been stabilized for a long time, more than 60% of the cases worsen when they are pregnant during the active period, but only 7% of the cases worsen when the disease is under control and only small doses of hormones are used. In addition, pregnancy during the active period is associated with a high risk to the fetus; (3) those with important organ involvement such as kidney, brain, heart and lung; (4) active kidney disease or blood creatinine >2mg/ml (176.8umol/L). Timing of pregnancy in patients with lupus: (1) no involvement of vital organs; (2) stable remission >1 year; (3) prednisone maintenance <10mg/day; (4) no immunosuppressive drugs for at least 6 months. Before pregnancy: (1) Visit obstetrics and gynecology department: check relevant items such as anti-Toxoplasma antibodies; (2) Visit rheumatology department and be well prepared: because 10-50% of patients have relapse of the disease during pregnancy or several months after delivery, lupus can cause miscarriage, premature delivery, stillbirth and intrauterine growth retardation, etc. Those with positive serum antiphospholipid antibodies are prone to miscarriage and intrauterine fetal death. (2) The first and second trimesters of pregnancy are the key observation periods, and hormones should be increased or decreased as appropriate: the first trimester is prone to miscarriage, and the second trimester and after delivery are prone to recurrence, so do not use drugs at will, and do not adjust the dose of hormones for stable patients. V. Principles of drug use in lupus patients after pregnancy: (1) Only use drugs when the adaptation is proven and the benefits (often for the mother) exceed the potential risks (often for the fetus) of the drug; (2) Avoid using any drugs (including over-the-counter drugs) in the first trimester; (3) Use the smallest effective dose and the shortest time; (4) Try to use drugs that have been widely used during pregnancy and have a good safety profile. (5) Most drugs with molecular weights <1500 can cross the placenta and may affect the fetus; (6) Avoid using multiple drugs at the same time. (6) Commonly used drugs are recommended: (1) Non-steroidal anti-inflammatory drugs: including drugs such as fentanyl, fotarine, lexon and mupirocin. These drugs are usually safe, but such drugs may cause fluid retention, aggravate hypertension and renal insufficiency, and should be avoided in the second trimester because they can also cause ductus arteriosus in immature fetuses. (2) Hormones: Except for fluorine-containing hormones such as dexamethasone and betamethasone, other hormones including prednisone, medrol and prednisolone can be used as they can be inactivated by the hydroxylase enzyme of the placenta and not absorbed by the fetus. However, hormones can also cause some more serious problems, including diabetes, hypertension, pre-eclampsia and premature rupture of membranes in immature fetuses. Therefore, if hormones are applied for a long time, prednisone or prednisolone doses should be less than 5 mg. For patients with extremely active lupus, it may be safe to use methylprednisolone in shock doses of 250 mg and 500 mg. (3) Immunosuppressants: In addition to azathioprine, cyclosporine and tacrolimus, other immunosuppressants including cyclophosphamide, methotrexate, mycophenolate, and leflunomide are contraindicated. (4) Hydroxychloroquine: This is the cornerstone drug for lupus treatment, which is important in controlling disease activity, preventing thrombosis, preventing relapse, reducing metabolic syndrome and enabling long-term survival of patients. Its safety in pregnant women with lupus or other connective tissue diseases has been demonstrated, and no fetal malformations, hearing and vision, or neurotoxicity have been reported. Moreover, the risk of lupus outbreaks is significantly higher after discontinuation of hydroxychloroquine during pregnancy. Therefore, hydroxychloroquine should not be discontinued after pregnancy. Because chloroquine phosphate is somewhat more toxic than hydroxychloroquine, patients using chloroquine phosphate are advised to switch to hydroxychloroquine. (5) Biologics: There is little experience with treatment in pregnant women, and further observation is needed. (6) Anticoagulants: low doses of aspirin and pentoxifylline are safe, various doses of heparin are safe, and ticlopidine (Ticlopidine) and clopidogrel (Bolivar) are contraindicated. Warfarin and coumadin are contraindicated during the fetal organogenesis period (6-10 weeks of gestation). Note: Patients receiving heparin anticoagulation should take calcium and vitamin D until the end of lactation. (7) Antihypertensive drugs: The antihypertensive drugs that can be used are mainly those older antihypertensive drugs such as methyldopa and nifedipine, while other antihypertensive drugs such as angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists and diuretics are prohibited because of their toxicity in causing fetal renal failure and amniotic fluid reduction. The use of angiotensin-converting enzyme inhibitors in early pregnancy has been reported to cause congenital malformations in the fetus. Treatment of active lupus in pregnant women: (1) The safety of the mother and fetus should be fully considered; (2) Hormone dose increase or methylprednisolone shock therapy; (3) Immunoglobulin shock therapy can be used; (4) CTX shock can be applied if the safety of the fetus is not considered. (8) Fetal monitoring in pregnant women with lupus: (1) Early pregnancy: starting from the 10th week, monitor fetal heart sounds at each visit; (2) Middle pregnancy: visit every 2 weeks to monitor fetal heart sounds, apply ultrasound in the 18th~20th week to check for congenital defects, assess the developmental status of the fetus by measuring the height of the uterine fundus, and apply ultrasound if necessary; (3) Late pregnancy: perform ultrasound every 3~4 weeks, and weekly (3) late pregnancy: ultrasound every 3~4 weeks, weekly uterine fundal height measurement to assess the developmental status of the fetus, and application of Doppler for biophysical detection (such as amniotic fluid volume, fetal movement, respiration and fetal heart sounds) in the 28th~30th week. Indications for termination of pregnancy in patients with lupus: (1) cardiac involvement: such as endocarditis, myocarditis and cardiac insufficiency; (2) progressive glomerulonephritis or renal failure; (3) nephrotic syndrome; (4) those with no obvious symptoms but significantly elevated immune monitoring indicators. (1) In general, pregnancy with stable disease and no obvious visceral damage can lead to safe delivery; (2) Hospitalization before delivery; (3) During delivery, gastrointestinal delivery time is prolonged due to slowed gastric emptying and weakened intestinal dynamics, so parenteral administration is often used; (4) At the time of delivery, hydrocortisone succinate should be administered at one times the prenatal hormone dose (200 mg/day). /day); postpartum day 1: hydrocortisone succinate 200-300mg IV; postpartum day 2: hydrocortisone succinate 160-200mg IV; postpartum day 3 resume prenatal dose, prednisone at least 10mg/d maintain for 6 weeks. Precautions for lupus patients during breastfeeding: (1) It is best not to feed the infant personally to avoid aggravating the physical and mental burden and the entry of antinuclear antibodies into the fetus through breast milk; (2) If you need to feed yourself, you should take more rest; (3) Prednisone and methylprednisolone are available, as they are only present in low concentrations in breast milk; (4) When prednisone >20mg/day, breastfeeding should be done 4h after taking the drug; (5) All (5) Immunosuppressants including Imuran are prohibited; (6) NSAIDs with a shorter half-life, such as ibuprofen, are available.