Can a 30-year-old woman with lupus nephritis get pregnant?

Question

Hello doctor,

My cousin is 30 years old and was diagnosed with lupus nephritis three years ago. Her condition is currently stable on immunosuppressive medication, but she has been told that pregnancy could be risky. We would like to understand whether she can safely conceive while on treatment or if she must wait until the disease is completely inactive.

We are also concerned about whether her kidney function could worsen during pregnancy and what warning signs we should watch for.

Could lupus nephritis cause complications such as preeclampsia or premature delivery?
Are there specific lupus medicines considered safe during pregnancy and breastfeeding?
Lastly, is it safer for her to consider IVF (in-vitro fertilization) or surrogacy in her case?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Safe and successful outcomes are possible but require careful planning and close surveillance. Since she is currently stable on immunosuppressive treatment, there is no need to wait until the disease is completely inactive. Still, it should remain well-controlled for at least three to six months before trying to conceive. Clinically stable disease reduces the risk of complications and improves maternal and fetal outcomes.

Lupus nephritis can increase the risk of preeclampsia, fetal growth restriction (FGR), preterm birth, and miscarriage. This is why regular monitoring is essential throughout pregnancy. Since she is on immunosuppressants, her medications should be reviewed and, if required, switched to safer alternatives.

Some medicines, such as Azathioprine, low-dose corticosteroids, and Hydroxychloroquine, are considered safe and are recommended during pregnancy. Pregnancy can sometimes trigger lupus flares, which may affect kidney function.

Warning signs to watch for include:

High blood pressure.
Swelling (especially in the face or hands).
Headaches.
Vision changes.
Epigastric pain.
Increasing protein in urine.

Regarding IVF (in-vitro fertilization), it should be considered only if infertility is present, as it does not reduce maternal risks. Surrogacy may be an option if maternal health makes pregnancy unsafe, especially if kidney function is poor or flares are frequent.

Before planning conception, the following should be checked:

Anti-dsDNA (double-stranded deoxyribonucleic acid) levels.
Renal function.
Other antibodies (such as anti-SSA (anti-Sjogren’s syndrome A) and anti-SSB (anti-Sjogren’s syndrome B)).
Baseline urinary protein (24-hour collection).

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.