Management for people with SLE during pregnancy
Management for SLE in pregnancy is directed by the specialist. Despite hydroxychloroquine being listed as a Therapeutic Goods Administration (TGA) category D drug1, hydroxychloroquine should be continued throughout pregnancy. For more information on immunomodulatory drug use and reproductive health in adults with rheumatological diseases, see Immunomodulatory drug use and reproductive health.
Antiphospholipid syndrome associated with SLE can manifest as obstetric antiphospholipid syndrome, with clinical features including recurrent early miscarriage, mid-trimester fetal loss and late-pregnancy complications (eg severe pre-eclampsia, stillbirth). Patients with antiphospholipid syndrome usually require thromboprophylaxis with low molecular weight (LMW) heparin and low-dose aspirin throughout pregnancy and for 6 weeks postpartum. See Management for obstetric antiphospholipid syndrome for more detail.
People with SLE and positive anti-Ro antibodies require special monitoring during pregnancy because of a risk to their fetus of developing congenital heart block. This is important when planning a pregnancy as fetal echocardiography is required at 18 to 20 weeks’ gestation.