1. Timing of pregnancy in sle patients
Pregnancy in sle patients must meet the following conditions: stable disease for at least 6 months, 24-hour urine protein quantification below 0.5g, oral glucocorticoid dose below 15mg/d (or equivalent dose of other dose of glucocorticoid), no serious organ damage, and discontinuation of immunosuppressive drugs for more than 6 months.
2. Pregnancy is contraindicated in patients with sle
(1) Severe pulmonary hypertension (estimated pulmonary artery systolic pressure above 50 mmHg, or clinical symptoms of pulmonary hypertension);
(2) Severe restrictive pulmonary pathology (FVC <1L);
(3) Cardiac failure;
(4) chronic renal insufficiency (serum creatinine level >2.8 mg/dl)
(5) Patients with previous severe pre-eclampsia or HELLP syndrome (hemolysis, high liver enzymes, thrombocytopenia) uncontrolled even after heparin and aspirin therapy;
(6) Patients who have had a stroke within the past 6 months;
(7) Patients with severe sle disease activity in the past 6 months.
3. Post-pregnancy monitoring
Follow up every 4-6 weeks until 20 weeks.
Every 2 weeks from week 20-28.
Week 28 until the end of delivery, once a week.
4.In addition to the clinical symptoms and signs of SLE, blood, urine routine, blood sedimentation and biochemical indexes should be checked during the follow-up.
Also need to monitor the dynamic changes of anti-ds-DNA antibody titer and blood complement level.
5.B ultrasound is also an important monitoring tool
Ultrasound examination can be performed in the 16th-20th weeks of pregnancy to detect abnormal development and malformation of the fetus at an early stage; after the 21st week of pregnancy, ultrasound examination can be performed every 4 weeks to monitor the growth and development of the fetus; if fetal growth retardation is suspected, it should be examined every 3 weeks.
6.Medications that can be used during pregnancy
During pregnancy, SLE patients may have some symptoms or need medications to treat the disease if it tends to recur. If you have joint pain or other painful symptoms, you can choose acetaminophen; NSAIDs can cause miscarriage in early pregnancy and premature closure of fetal arteries in late pregnancy, so they are only used in the middle of pregnancy.
Prednisone or methylprednisolone can be used when SLE is recurrent or maintenance therapy is needed, and fluorinated glucocorticoids are prohibited.
Hydroxychloroquine has been shown through clinical studies to be safe for pregnancy and to reduce the risk of thrombosis in patients with antiphospholipid antibodies.
Azathioprine, although in the US FDA pregnancy drug class D, may be considered for use during pregnancy in SLE patients for disease control.
Intravenous immunoglobulin infusion is also safe.
7. Drugs prohibited during pregnancy
Motilmic acid, leflunomide, methotrexate, cyclophosphamide and salazosulfapyridine are prohibited drugs because of their teratogenic effects.
8.Cyclosporine
Although it also belongs to the US FDA pregnancy category D drugs, it can be considered for use in SLE patients with important organ damage and serious hematological abnormalities, but with caution.