Can I take Hydroxychloroquine for lupus during my pregnancy?

Question

Hello doctor,

I was diagnosed with lupus nephritis two years ago, and now I am 12 weeks pregnant and really worried about my kidneys. My rheumatologist had to stop the Methotrexate when we found out about the pregnancy, but my joint pain came back with a vengeance. My latest labs show protein in my urine at 2.4 grams per day, which is higher than before I got pregnant. Blood pressure has been running 150/95 even on Labetalol, and my feet are swelling really badly.

The maternal-fetal medicine doctor is talking about early delivery if things get worse. My creatinine went from 1.2 to 1.8 in the last month, and the nephrologist seems concerned. I have been having terrible fatigue and brain fog that makes it hard to work. The Prednisone helps with the joint pain, but makes me gain weight and gives me mood swings. My complement levels (C3 and C4) are low, and anti-dsDNA antibodies are high again.

What are the chances this lupus nephritis will damage my kidneys permanently?
Is it safe to continue the Hydroxychloroquine during pregnancy?
Will my baby be okay if my kidney function keeps declining?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand how stressful and frightening it is to face lupus nephritis during pregnancy. Your concerns about your kidneys and your baby’s health are completely valid. Your rising proteinuria (2.4 grams/day), worsening blood pressure (150/95), increased creatinine (1.8), and low complement (C3 and C4) / high anti-double-stranded deoxyribonucleic acid antibodies indicate active lupus nephritis.

Fatigue, brain fog, joint pain, and swelling are common with both disease activity and steroid therapy. Lupus nephritis can sometimes cause permanent kidney damage, especially if disease activity is high or uncontrolled. Early intervention and close monitoring significantly reduce this risk. Frequent labs, blood pressure control, and adjusting medications are crucial to protect kidney function.

Hydroxychloroquine is considered safe and is recommended during pregnancy; it can help reduce flares and protect both kidneys and the baby.
Steroids are often continued at the lowest effective dose to control disease, despite side effects.
Active lupus nephritis and high blood pressure increase the risk of preterm delivery, growth restriction, and complications, which is why your maternal-fetal medicine team is closely monitoring you.
With careful management, many women with lupus nephritis carry healthy pregnancies, though early delivery may sometimes be necessary to protect mother and baby.
Your situation is high-risk, but with close coordination between your nephrologist, rheumatologist, and obstetric team, kidney function can often be preserved, and pregnancy outcomes optimized.
Monitoring and timely adjustments are key.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.