Page 54 - e-CPG-SLE-8_5_24

Management of Systemic Lupus Erythematosus

Oral contraceptive and intrauterine device (IUD) have no association
with thrombosis, worsening of SLEDAI score and mortality in patients
with SLE. 15, level I; 109, level I Refer to Appendix 10 for the Types of
Contraception Recommended for Patients with SLE.

Recommendation 12
• All women with systemic lupus erythematosus in the reproductive
age should receive pre-pregnancy counselling.

b. Antenatal care
The management principles for SLE during pregnancy are as follows:
• Obstetric Care: Standard pregnancy care protocols provided by
the obstetric team shall be followed.
• Rheumatological or Subspecialty Care: The rheumatologist
or a subspecialty team will co-manage any disease-related
complications and ensure optimal care for the patient.
• Combined Care: Effective communication and multidisciplinary
care among healthcare providers co-ordinated by family medicine
specialists are essential.
The management of pregnant women with SLE is tabulated below
(refer to Table 4).
Table 4: Management of Pregnant Women With SLE
Timeline Monitoring Action Plan
First • Blood pressure • Start low dose aspirin
trimester • SLE clinical assessment • Be vigilant for disease flares
• Laboratory investigation* • Review medication compatibility
• Foetal ultrasound to confirm and adherence
intrauterine pregnancy and • Patients with obstetric-APS** - start
establish gestational age prophylactic LMWH
• Patients with thrombotic APS** -
switch from oral anticoagulants to
full dose LMWH
• For active SLE:
 medication adjustment
 MDT discussion and shared
decision-making
for continuation of pregnancy in
certain situations
• Schedule for combined care
Second • Blood pressure • Be vigilant for disease flares
trimester • SLE clinical assessment • Review medication adherence
• Laboratory investigations* • Calcium supplementation for
with assessment for pre-eclampsia prophylaxis if not
gestational diabetes and started previously. The recommended
genetic screening dose is calcium carbonate 1 g BD
(if applicable) commenced before 20 weeks
• Foetal echocardiogram gestation.
between 16 - 25 weeks of • congenital heart block,

37
gestation for mothers with co-management with feto-maternal
positive anti-Ro/SSA or specialist is required
anti-La/SSB by feto-maternal
specialist
• Ultrasound to evaluate foetal
anatomy, foetal growth and
placental insufficiency
Third • Blood pressure • Be vigilant for disease flares
trimester • SLE clinical assessment • Review medication adherence
• Laboratory investigations* • Review preparations for labour and
• Regular ultrasound to delivery
evaluate foetal growth, • Avoid NSAIDs
adequacy of amniotic fluid
and placental insufficiency
Post- • Blood pressure • Be vigilant for disease flares
partum and • SLE clinical assessment • For APS - continue LMWH for
lactation • Laboratory investigations* 6 weeks
• Switch to lactation compatible
medications if breastfeeding is
desired
• For prednisolone ≥40 mg/day,
delay breastfeeding at least four
hours after consumption
• Refer neonate to paediatrician to
rule out neonatal lupus
• Advise regarding contraception***