Preconception Care for Women with Systemic Lupus Erythematosus

Essential Preconception Medications

The American College of Rheumatology recommends continuing hydroxychloroquine preconceptionally and throughout pregnancy for all SLE patients unless contraindicated, as it reduces disease activity and improves obstetrical outcomes 1, 2
Oral glucocorticoids should be used at the lowest effective dose (ideally ≤7.5 mg/day prednisone equivalent) to minimize side effects 1, 2
ACE inhibitors/ARBs are teratogenic in the first trimester and should be switched to nifedipine or labetalol 1

GnRH analogues should be considered for all menstruating women with SLE who require alkylating agents to preserve fertility 3, 4
Women should be counseled about fertility issues, especially adverse outcomes associated with increasing age and alkylating agent use 3, 4

Ovulation induction treatments and in vitro fertilization protocols can be safely used in patients with stable/inactive SLE 3, 4
Disease must be stable/inactive before proceeding with assisted reproduction 3, 4

Lupus should be in stable remission for 6-12 months before conception to minimize flare risk and adverse pregnancy outcomes 1
Active disease at conception significantly increases flare risk and adverse pregnancy outcomes 1

Low-dose aspirin (81 mg daily) should be started preconceptionally or no later than gestational week 16 to reduce pre-eclampsia risk, particularly for patients with lupus nephritis or antiphospholipid antibodies 1
For patients with definite APS, combination therapy with low-dose aspirin plus low-molecular-weight heparin (or unfractionated heparin) should be planned for throughout pregnancy 1

Active/flaring SLE, especially active nephritis, increases risk of adverse maternal and fetal outcomes and must be optimized 3, 4
History of lupus nephritis increases risk of adverse maternal and fetal outcomes and must be optimized 3, 4
Presence of antiphospholipid antibodies/APS increases risk of adverse maternal and fetal outcomes and must be optimized 3, 4
Uncontrolled hypertension increases risk of adverse maternal and fetal outcomes and must be optimized 3, 4