Page 53 - e-CPG-SLE-8_5_24

Management of Systemic Lupus Erythematosus

Recommendation 11
• Patients with systemic lupus erythematosus (SLE) who have
high-risk antiphospholipid antibody profile may receive primary
thromboprophylaxis with low dose aspirin if there are no
contraindications.
• Secondary thromboprophylaxis in patients with SLE who have
antiphospholipid syndrome should be initiated in consultation with a
rheumatologist.

10.2 Pregnancy
a. Pre-pregnancy care and contraception
Pre-pregnancy care is the provision of biomedical, behavioural and
social health interventions to women and couples before conception. It
aims at improving their health status, as well as reducing morbidity and
mortality of both mother and child.

• It is important to ensure that patients with SLE who plan to get
pregnant achieve the following: 104
 remission or low disease activity for ≥6 months
 well-controlled blood pressure
 eGFR >60 mL/min/1.73 m 2
 proteinuria <1 g/day (proteinuria 2+)

Counselling on contraception is important to patients with SLE who
have just started on medication. This is to ensure that patient is stable
on the pregnancy-compatible medication before conception.
A meta-analysis of six cohort studies showed that maternal adverse
pregnancy outcomes in SLE were pre-eclampsia, miscarriage,
foetal loss, risk of caesarean delivery and still birth while foetal
complication were pre-term birth, small for gestational age and low birth
weight. 105, level II-2

Associated factors of adverse pregnancy outcomes in SLE are presence
of active disease, aPL positivity, abnormal uterine and umbilical artery
Doppler studies, low complement and thrombocytopenia at early
pregnancy. 106 - 107, level II-2
A cross-sectional study among women with SLE found that a third of
them did not receive contraception counselling when they were started
on potentially teratogenic medications. 108, level III Thus, it is crucial for
women with SLE especially those in reproductive age group to receive
a thorough pre-pregnancy counselling on contraception and combined
care of the rheumatologist and obstetrician once they are pregnant.

36