At a symposium sponsored by the American College of Rheumatology, Dr. Megan Clowse of Duke University noted that the risk of active systemic lupus erythematosus (SLE) in pregnancy is much higher than the risk of most drugs: active SLE in pregnancy increases the risk of pregnancy loss by a factor of 1, active SLE in the first trimester increases the risk of pregnancy loss by a factor of 3, and there is no There is no drug that causes a 40% pregnancy loss rate. Therefore, pregnant women with active SLE should be on continuous medication. The best drug to prevent acute exacerbation of SLE is hydroxychloroquine (Plaquenil). Hydroxychloroquine is classified as a pregnancy Category C drug because of hearing abnormalities observed in children using high doses of chloroquine (Aralen), but hydroxychloroquine itself poses no significant risk to the fetus, especially when applied at therapeutic doses for rheumatic diseases. Some reports suggest that discontinuation of hydroxychloroquine during pregnancy may promote acute exacerbation of SLE, which in turn may lead to a worse prognosis for pregnancy. If the patient has been off hydroxychloroquine for many years and has no symptoms of SLE during pregnancy, hydroxychloroquine is not needed. Azathioprine (Azasan, Imuran) may be considered for women with a high degree of SLE activity. This drug is classified as a pregnancy category D drug because of the risk of fetal immunosuppression observed at delivery. The incidence of preterm delivery is higher in renal transplant patients compared to SLE patients, and extensive data from renal transplant patients support the use of azathioprine for SLE in pregnancy. azathioprine is the most effective drug for preventing acute exacerbations of SLE in pregnancy, but its efficacy in treating acute exacerbations of SLE in pregnancy is less significant. in his latest study, Dr. Clowse found that in women with high SLE activity Azathioprine did not prevent pregnancy loss and was instead associated with an increased rate of pregnancy loss. When an acute exacerbation of SLE occurs, prompt treatment is indicated. Prednisone is probably the most effective treatment, but intravenous immunoglobulin infusion may also be a reasonable option. Prednisone is metabolized through the placenta and only 10% of the maternal dose reaches the fetus. In contrast, the fluorinated corticosteroid betamethasone (Betnesol injection) is not metabolized by the placenta and reaches the fetus and therefore should not be used during pregnancy. Prednisone may cause a reduction in birth weight and can lead to a 2-fold increase in the risk of cleft lip and cleft palate occurrence, but this risk mainly affects early gestation. Medications that should be avoided during pregnancy include cyclophosphamide (Cytoxan), mycophenolate mofetil (CellCept), and belimumab (Benlysta). An analysis of 26 pregnancies in 18 kidney transplant patients treated with mycophenolate mofetil revealed that 11 pregnancies ended in spontaneous abortion, 10 were preterm, and 4 were congenital anomalies (Transplantation 2006;82:1698-702). The incidence of birth defects was 26%, higher than the 3% observed in the general population, and in three cases the infants had microtia, which is not simply an underdevelopment of the ear, but an ear located in the wrong position on the head, resulting in deafness in the infant. Although beribizumab has not been observed to be teratogenic in animals, GlaxoSmithKline recently conducted a global beribizumab pregnancy registry study to prospectively collect birth defects and other pregnancy prognostic numbers in women using beribizumab in the first 4 months of pregnancy or during pregnancy. dr. Clowse indicated his recent use of aspirin 81 mg/d to prevent the development of SLE in pregnancy in patients with pre-eclampsia. Data from high-risk non-Lupus patients suggest that aspirin reduces the risk of preterm delivery, preeclampsia, maternal hypertension, and low birth weight, and does not increase the risk of congenital anomalies or ductus arteriosus. Pregnant women with SLE should be closely monitored by rheumatologists and obstetricians. Important monitoring items include: hypertension: especially during pregnancy, as hypertension can lead to a 40% increased risk of pregnancy loss, preterm delivery and preeclampsia; proteinuria: due to increased renal function, proteinuria may increase slightly during pregnancy, and a more than 1-fold or 1 g increase in urine protein should be taken into account for the best prognosis of pregnancy. For the best prognosis, it is recommended that female patients avoid pregnancy during active SLE. In patients with SLE, progesterone contraception alone is probably the safest method of contraception, with meprogesterone injection (Depo-Provera) usually well tolerated and 3-year etopregnanolide implant (Implanon) better tolerated than levonorgestrel implant (Norplant).