Instructions for safe use of pregnant women with lupus erythematosus

Systemic lupus erythematosus (SLE) is more common in women of childbearing age, and pregnancy and childbirth are important concerns for
patients and families.
Recently, I saw a patient on the platform ask: Can lupus patients continue to take medicine after they are pregnant? What are the principles and precautions for medication during pregnancy? Today we will answer this question in detail how lupus patients should take medication
safely during pregnancy.

SLE patients are pregnant to meet certain conditions, first of all, they must be stable for at least half a year and have no important organ damage, followed by stopping immunosuppressants such as methotrexate and leflunomide for at least half a year or more
, and using hormones in small doses.
If you do not meet the above conditions and become pregnant unexpectedly, consult a rheumatologist to determine whether to terminate the pregnancy
.

Medication for SLE during pregnancy is a challenge for clinicians because pregnancy may increase disease activity and frequency of recurrence, and may lead to adverse pregnancy outcomes such as preterm birth, miscarriage, and stillbirth
.
Therefore, patients should be more cautious
in their use during pregnancy.
But do not stop the drug at will!

Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen, diclofenac, meloxicam, celecoxib, and etoricoxib are the cornerstones of SLE therapy and should be used with caution in the first and second trimesters of pregnancy and avoided
in the third trimester (> 30 weeks).
If needed, use low-dose and non-selective NSAIDs (e.
g.
, ibuprofen)
if desired.

Glucocorticoids: Glucocorticoids are best used to use prednisone or prednisolone, because prednisone can be inactivated by 11-β-dehydrogenase produced by the placenta, thereby avoiding adverse effects
of the drug on the fetus.
The lowest possible dose of the hormone is used, and the ideal maintenance dose is the equivalent of prednisone ≤ 7.
5 mg/day
.
Other corticosteroids such as dexamethasone and betamethasone may affect fetal development and should not be used
.

Hydroxychloroquine: hydroxychloroquine is safe and well tolerated and is the cornerstone of
all patients with lupus erythematosus.
Studies have shown that hydroxychloroquine has a good safety profile for pregnant women and fetuses with SLE and can be used continuously during pregnancy
.

Immunosuppressants: methotrexate, cyclophosphamide, mycophenolate mofetil, leflunomide and other immunosuppressants are prohibited
during pregnancy.
Azathioprine is relatively safe and is used when immunosuppressants must be used
.

Disease activity should be closely monitored during pregnancy, and hormone dose should be appropriately increased if the disease worsens or relapses, and hormone shock therapy
can be considered if the degree of inflammation is heavier or important organ damage occurs.

Be cautious with medication during pregnancy! Refusal of medication is not advisable!

The degree of effect of the drug on the fetus depends on factors
such as the nature of the drug, the dose and time of administration, the toxicity of the drug, the permeability of the placenta, and the fetus's own sensitivity to the drug.
Although some drugs are not harmful to the mother, they have a damaging effect on the fetus, so you should consult a professional doctor
before taking the drug.

(1) Consult a professional doctor before taking the drug, and do not buy it
yourself.

(2) When taking drugs, pay attention to the words "pregnant women should be used with caution, contraindication, and prohibition" on the package
.

(3) Medication must pay attention to gestational age, and strictly control the dose and duration
.
Adhere to rational drug use, and stop the drug
in time after disease control.

(4) Make it a habit to record medication so that you can assess the effects
of drugs on the fetus.

(5) Mainly to control the condition of lupus, do not stop the drug
at will.

END

Safe medication is an important lesson in pregnancy for patients with systemic lupus erythematosus, and only by mastering the correct medication principles and precautions can the impact
on the fetus be reduced.
In addition, patients should have regular prenatal check-ups and pass the pregnancy safely under the supervision of obstetricians and
rheumatologists.
Especially in the first and last trimesters of pregnancy, we must focus on observation, add or subtract hormones as appropriate, but do not take or stop taking drugs at will
.

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