Is it safe to treat lupus nephritis during my pregnancy?

Question

Hello doctor,

I have lupus nephritis, and my nephrologist has confirmed that I am currently in remission. My partner and I are hoping to start trying for a baby, but I feel overwhelmed with fear and uncertainty. I understand that pregnancy with systemic lupus erythematosus (SLE), especially when the kidneys are involved, can carry significant risks. I am particularly concerned about potential disease flares, the safety of my medications, and whether there is a chance of passing on a genetic predisposition to lupus. Some of the medications I am currently taking carry pregnancy-related warnings, and I am unsure which ones are safe to discontinue and which should be continued. I would like to know which treatments for lupus nephritis are considered safe during pregnancy and how pregnancy might affect my kidney function. I want to approach this journey with careful planning and medical guidance to protect both my health and the health of a future baby.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Pregnancy in the context of lupus nephritis can understandably cause anxiety, but with careful planning and medical guidance, many women have healthy pregnancies and babies. Being in remission is crucial; ideally, systemic lupus erythematosus (SLE), especially with kidney involvement, should be stable for at least six months before conception to reduce risks such as preeclampsia, preterm birth, miscarriage, and worsening kidney function. Some lupus nephritis medications, like Mycophenolate Mofetil (CellCept) and Cyclophosphamide, are not safe during pregnancy due to their teratogenic effects and must be stopped well in advance.

Safer alternatives include Hydroxychloroquine (Plaquenil), Azathioprine at doses up to 2 milligrams per kilogram per day, low-dose Prednisone, and low-dose Aspirin to help prevent complications. Pregnancy puts extra strain on the kidneys, so close monitoring of blood pressure, proteinuria, kidney function, and lupus activity markers by your nephrologist and obstetrician is essential. Although lupus is not directly inherited, a slight genetic susceptibility exists, and testing for anti-Ro/SSA and anti-La/SSB antibodies is important due to the small risk of neonatal lupus. Early involvement of a maternal-fetal medicine specialist and preconception counseling with your rheumatologist and nephrologist is vital to creating a safe, individualized plan. With the right support, pregnancy can be safe and successful for women with lupus nephritis in remission.

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

Thank you.