Managing lupus patients during pregnancy

Pregnancy still constitutes a major challenge for women with systemic lupus erythematosus. Coordinated medical/obstetric care is essential to maximise the chance of success. Pregnancy should be planned in advance, following a pre-conceptional visit in which the specific risk for complications can be assessed. Previous complicated pregnancies, renal disease, irreversible damage, anti-phospholipid antibodies and treatment with high-dose steroids are adverse features. Pregnancy should be discouraged in women with symptomatic pulmonary hypertension, heart failure, severe restrictive pulmonary disease, severe chronic renal failure and recent serious lupus activity. Treatment is based on hydroxychloroquine, low-dose steroids, azathioprine and in patients with anti-phospholipid antibodies, low-dose aspirin+/-low molecular weight heparin. Close surveillance, with monitoring of blood pressure, proteinuria and placental blood flow by Doppler studies helps the early diagnosis and treatment of complications such as pre-eclampsia and foetal distress. Post-partum follow-up is also essential.