Do these 8 points well, lupus patients can also overcome the difficulty of recurrence and welcome a new life!

Although pregnancy does not alter the long-term prognosis of patients with systemic lupus erythematosus, studies have shown that changes in estrogen and prolactin levels during pregnancy lead to an enhanced immune response, and pregnancy can also increase the burden on the affected heart and kidneys, leading to an exacerbation or recurrence
of lupus.
In addition, the secretion of glucocorticoids increases during pregnancy, but the rapid decline after childbirth can also lead to a rebound in lupus condition.
.
.
[1]

It seems that lupus patients still have many difficulties to overcome if they want to safely conceive a new life, so can safe pregnancy and disease control be both?

Many patients worry about this day and night, but don't worry, Kopujun will give you a question and answer about the pregnancy of lupus patients, and drive away the worries between your eyebrows~

Q1

Systemic lupus erythematosus does have a certain genetic predisposition
.
But it is not a single-gene genetic disease, in addition to genes, estrogen levels, viral infections, ultraviolet rays and other factors may also be involved in the development of
lupus.

In addition, epidemiological data show that although the risk of lupus in the immediate family of lupus patients is higher than that of ordinary people, the incidence of neonatal lupus abroad has only reached 1/12500~1/20000, which is extremely rare (and neonatal lupus also includes some mothers who do not have lupus, but newborns have lupus), which means that the probability of children suffering from lupus at birth is very low
.

Moreover, in recent years, with the improvement of medical standards, more and more lupus patients can be "completely" prepared with the help of doctors before deciding to become pregnant, so as to meet the advent of a healthy new life with better disease control and physical conditions [2].

Q2

Patients with systemic lupus erythematosus whose condition is stable or whose disease is inactive can safely use assisted reproductive technologies such as ovulation induction therapy and in vitro fertilization as IVF under the guidance and evaluation of rheumatology and immunologists and obstetricians and gynecologists, and after successful pregnancy, it is still necessary to regularly monitor the changes of the condition and standardize the rational use of drugs [3].

Q3

Before planning pregnancy, lupus patients should consult their rheumatologists and obstetricians and gynecologists for fertility consultation and conduct pregnancy risk assessment (such as disease activity, severity, whether there is organ damage and current treatment drugs, etc.
), to ensure that their physical condition and disease control meet the indications for pregnancy before preparing for pregnancy, and oral folic acid as soon as possible during pregnancy preparation to prevent fetal malformations
.
[1，4]

Q4

The Guidelines for the Diagnosis and Treatment of Systemic Lupus Erythematosus in China (2020) point out that patients with lupus suitable for pregnancy need to meet the following requirements:

(1) Lupus is inactive and stable for at least half a year; (2) The dose of glucocorticoids is prednisone <15mg/d (or equivalent dose of other glucocorticoids); (3) 24-hour urine protein excretion quantification is less than 0.
5g; (4) Stop using immunosuppressive drugs such as cyclophosphamide, methotrexate, triptovine, mycophenolate mofetil for at least half a year; (5) Lupus patients taking leflunomide should first undergo drug clearance therapy, and then stop taking the drug for at least half a year before considering pregnancy; (6) There is no damage to important organs, such as heart, lung, kidney damage, etc.
[1,4].
<b10>

Q5

Patients with lupus should regularly go to the rheumatology and immunology department for examination during pregnancy, including blood routine, urine routine, 24-hour urine protein excretion quantification, liver and kidney function, serum complement, immunoglobulin quantification, anti-ds-DNA antibody level, etc.
, it is recommended that patients be followed up every 4 weeks before 28 weeks of pregnancy, and every 2 weeks from the 28th week
.

Tips: If the patient's serum anti-SSA or anti-SSB antibody is positive or the fetus has had cardiac abnormalities before, it is recommended to perform cardiac ultrasound every 2 weeks during 16~24 weeks of pregnancy, and hydroxychloroquine (200mg, 2 times / d) can also be used under the doctor's advice to reduce the probability
of fetal heart block.

At the same time, patients should also regularly go to the obstetrics and gynecology department for relevant examinations, including routine obstetric examination, blood pressure monitoring, fetal heart rate monitoring, etc.
, it is recommended that patients be followed up every 4 weeks before 28 weeks of pregnancy, and every 2 weeks from the 28th week, and at the same time at 16 weeks of pregnancy, patients should undergo fetal ultrasound examination once a month to monitor fetal growth and avoid fetal
malformations.
[5]

Q6

First of all, in patients with lupus after pregnancy, in order to maintain the stability of the disease as much as possible, reduce the chance of lupus recurrence and premature birth caused by the disease, and reduce the risk of adverse fetal outcomes, in the absence of contraindications, patients should follow the doctor's advice to continue taking hydroxychloroquine
throughout pregnancy.
Second, studies have shown that nearly half of patients with lupus will have disease activity or recurrence during pregnancy, so for patients with disease activity during pregnancy, use fluorinated glucocorticoids, hydroxychloroquine and immunosuppressants (eg, azathioprine, cyclosporine A, tacrolimus, etc.
) as directed to control the disease
.
[4]

Q7

First of all, neonatal lupus refers to newborns born to mothers with anti-SSA/Ro antibodies and/or anti-SSB/La antibodies, and the mother of the newborn does not necessarily have systemic lupus erythematosus, but also has the possibility
of rheumatic diseases such as Sjogren's syndrome, rheumatoid arthritis, and mixed connective tissue disease.

Secondly, neonatal lupus has a transient, skin manifestations, the probability of irreversible heart damage is low, children with mild symptoms only need to pay special attention to avoid sunlight in daily life, reasonable use of sunscreen, severe symptoms need to use low-potency topical corticosteroids under the advice of a doctor, basically about 6 months, skin damage will gradually relieve until it disappears
.
[6]

Q8

In order to promote healthy fetal development and maternal recovery, existing guidelines recommend postpartum breastfeeding in patients with lupus, in which oral prednisone or methylprednisolone, hydroxychloroquine, and nonsteroidal anti-inflammatory drugs can be breastfed, and lupus patients taking aspirin and warfarin and heparin can also breastfeed
normally.

However, breastfeeding is not recommended in patients taking cyclophosphamide, mycophenolate mofetil, methotrexate, leflunomide, azathioprine, cyclosporine A, and tacrolimus, while patients with oral prednisone doses above 20 mg/day or equivalent should abandon milk within 4 hours of taking the drug and breastfeed
after 4 hours after taking the drug.
[5]

Written in

At last

In short, compared with ordinary people, systemic lupus erythematosus does put a layer of shackles on the normal pregnancy of patients of childbearing age, but it is not without restrictions on the freedom of patients to embrace new life, as long as it meets the indications for pregnancy of lupus patients, go to rheumatology and immunology and obstetrics in time before pregnancy for various physical and disease assessments and examinations, carefully listen to the doctor's advice to adhere to drug treatment, reasonable control of diseases, lupus patients can also give birth to healthy babies~

Systemic lupus erythematosus