Choose the right time to reduce the risk A prerequisite for pregnancy and childbirth in lupus erythematosus is to obtain disease remission. Hormones can only reduce the symptoms of lupus erythematosus; induction of disease remission depends on immunosuppression. Once the disease is in remission, the timing of pregnancy and childbirth can be discussed with the doctor to ensure the safety of the mother and the health of the child. Most patients in complete remission can have a pregnancy and childbirth as normal; 10% to 30% of patients will experience fluctuations in their disease during pregnancy and need to adjust their medication on an outpatient basis; about 10% of patients need to be hospitalized for lupus; only a very small number of patients will experience significant exacerbation and need to terminate the pregnancy to treat the mother; as with non-pregnant lupus, individual patients will have a relapse that will endanger Life. Because estrogen plays an important role in the pathogenesis of lupus erythematosus, and changes in sex hormones occur during pregnancy, especially elevated levels of estrogen and prolactin, which continue to enhance the body’s immune response. Therefore, although most lupus erythematosus can be born in pregnancy without any problems, there is still a risk of lupus erythematosus activity and exacerbation of symptoms. Besides, the increased cardiac and renal burden on the mother during pregnancy, due to the metabolic needs of the fetus and being in a state of stress, is also a factor that causes lupus erythematosus to flare up. If the disease worsens during pregnancy, it is necessary to adjust the medication according to the condition. The medication needs to pay attention to the safety of the fetus. After the middle of pregnancy, oral prednisone not more than 30mg daily has little effect on the fetus; oral hydroxychloroquine, cyclosporine and azathioprine also have little effect on the fetus (note: the view after 2010 is that oral hydroxychloroquine is advocated to continue during pregnancy); while dexamethasone, cyclophosphamide and methotrexate can affect fetal development and are contraindicated drugs in pregnancy. If the condition is severe, the pregnancy needs to be terminated so that high doses of hormones and drugs such as cyclophosphamide can be used to save the mother. It is important to have adequate communication between the doctor and patient at this time to obtain the best possible solution. Childbirth causes a significant increase in maternal lactogen levels, and high estrogen levels take several months after delivery to slowly decrease to non-pregnant levels. Therefore, the postpartum period is also a risky time for lupus erythematosus to flare up. In the past, the medical profession advocated that high doses of hormones and immunosuppressants should be given starting immediately after delivery. Although these drugs are a serious setback for the postpartum weakened mother, they are the only option to prevent the recurrence of lupus erythematosus. Happily, in recent years, some scholars have found that bromocriptine given orally for two weeks after delivery can cause maternal lactogen and estrogen levels to drop rapidly to non-pregnant levels, thus effectively preventing postpartum lupus erythematosus flare-ups. Getting the timing right There is no uniform standard for the timing of pregnancy and childbirth in lupus erythematosus patients. In general, if the hormone is reduced to a small dose (prednisone ≤10mg per day), and this small dose is maintained for more than six months, and the blood indicators related to lupus erythematosus are stable on review, and the urine examination is normal, pregnancy and childbirth can be considered. If there are mild fluctuations in the disease after six months of maintenance of the small dose of hormones, the decision of pregnancy needs to be made according to the actual condition of the patient. The risks of pregnancy and childbirth need to be discussed with an experienced physician at this time. In mildly active cases, although the risk increases during the October pregnancy, most pregnancies are still successful, depending on the couple’s urgency to have a child. If the disease is moderately active, pregnancy should be temporarily abandoned and disease progression should be managed first. Although most patients can achieve complete remission, more than half of them will relapse at some time after remission, and about 20% of them cannot achieve complete remission and can only be controlled in a moderate or low activity state for a long time. Therefore, it is important to take advantage of the timing of pregnancy to have a child with lupus erythematosus. If you have plans to have children, you should discuss the timing of pregnancy with your doctor when you reach complete remission. Adjust the medication in a planned way and have a planned pregnancy and childbirth. Some patients do not want to have children when the timing of pregnancy is reached, and when they want to have children, their disease is unstable, leading to regret.