SLE and pregnancy: Joining the dots

The final presentation at the Irish Society for Rheumatology Spring Meeting 2023 was delivered by Dr Natasha Jordan, Consultant in Adolescent Rheumatology at St James’s Hospital and Children’s Hospital Ireland. Dr Jordan delivered a talk on ‘Management of SLE in pregnancy’. She discussed systemic lupus erythematosus(SLE) in pregnancy and stressed to the attendees that the risk of a flare-up of lupus in pregnancy is highly dependent on the date of activity of the lupus in the six-to-12 months before the patient conceives. “So ideally, you do not want a patient with active lupus patient getting pregnant, but it does happen,” she said. 

“The big ‘no-no’ is that active lupus nephritis conception is really not a good place to be and, in fact, a patient who has had a past history of lupus nephritis, even if it is now in remission, is more at risk than a non-renal lupus patient,” said Dr Jordan. “The pregnancy itself does not seem to endanger long-term renal function, but as a general rule, the higher the creatinine going into pregnancy, the higher the risk of deterioration. We do see flares in pregnancy but for the most part they are mild — skin, joints, mild haematological [symptoms], but we do unfortunately also see severe flares with organ involvement, such as renal and the central nervous system, and we have to be highly vigilant for that.”

Dr Jordan briefly described the pre-pregnancy assessment procedure and gave the conference a case study of neonatal lupus, as well as postpartum follow-up procedures. She described the importance of medication reviews with these patients and the need to establish whether their medications are safe in pregnancy. “The message you really want to get across to the lady is that continuing safe and appropriate medications is far safer for her and the baby than stopping all medications, which some ladies want to do, and then having a flare in the middle of pregnancy.”

She continued: “There is not one ‘recipe’ for every lupus patient going into pregnancy; it’s very much tailored to the individual woman. We advise early booking when they have their positive pregnancy test and if they are on warfarin for anti-phospholipid, that they know how to self-inject low molecular-weight heparin and that they have a supply at home. This means that when they get a positive pregnancy test, they don’t get into a panic trying to contact the GP or pharmacist and it is all in hand.”