Recommendations for a woman anticipating pregnancy with a history of SLE nephritis
- • Stop renin–angiotensin blockade medications prior to conception:
- • Patients should be in remission for at least 6 months.
- • Follow proteinuria off angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker prior to pregnancy; expect baseline proteinuria to increase with increased glomerular filtration rate during pregnancy.
- • Hydroxychloroquine may help prevent intrauterine growth restriction.
- • Anti-dsDNA levels are not affected by pregnancy and can be followed as a sign of disease flare in some individuals with increasing proteinuria.
- • The risk of renal biopsy is likely not increased for patients in the first and second trimester (if aPLA-negative and not on anticoagulation), but best done prior to pregnancy if there is a concern for active nephritis.
Pearl: complements are elevated during pregnancy, so even normal levels that are dropping may indicate an SLE flare.
