What's on this Page
Can I pregnant with lupus nephritis
Is it advisable for a woman with lupus nephritis to get pregnant?
Both SLE and lupus nephritis commonly occur in women of childbearing age. Women with lupus nephritis have higher rates of maternal complications during pregnancy, including preeclampsia (difficult to distinguish from a lupus flare) and preterm delivery. Fetal complications are also more common, such as low birth weight or even fetal loss.
Patients with antiphospholipid antibodies are prone to develop spontaneous abortions and fetal loss. Anti-Ro/SSA and anti-La/SSB antibodies can cross the placenta and cause cutaneous neonatal lupus and/or congenital heart block.
Prepregnancy counseling is recommended. The maternal-fetal risk of complication is lower in patients with normal kidney function, normal blood pressure, a lack of antiphospholipid antibodies, and inactive disease.
How should pregnant patients be managed differently?
If pregnancy is a consideration or if it occurs, a multidisciplinary approach with an obstetrician who specializes in high-risk pregnancies is recommended. Assessment for lupus serology, proteinuria, kidney function, and systemic and pulmonary hypertension is necessary.
Medications should be carefully reviewed and, if possible, those that have high teratogenic potential should be discontinued in favor of those that have less. Medications used frequently that exhibit teratogenicity include cyclophosphamide, MMF, ACEIs and ARBs, and hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors.
However, the outcome of the pregnancy is directly related to maternal health, and if severe lupus nephritis develops or flares during pregnancy, these medications may be considered so as to prevent the onset of kidney failure.
