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Management of Systemic Lupus Erythematosus

studies also showed no significant association of HCQ use and foetal
loss, pre-term delivery and pre-eclampsia. 111, level II-2; 112, level II-2; 113, level II-2

Corticosteroids is also the cornerstone treatment in pregnancy.
However, its dose should be reduced to lowest effective dose prior
to conception to ensure its safety in pregnancy. In a meta-analysis of
overall good quality primary studies, the use of corticosteroids >7.5 mg/
day was associated with risk of pre-term delivery, small gestational age
and foetal loss. 114, level II-2 Nevertheless, CPG DG opines that for mild
to moderate SLE flare, a dose increment may be considered but then
tapered accordingly.

HCQ, AZA, CNIs and low dose corticosteroids are safe to be used
throughout pregnancy as recommended by guidelines. 46

ACR recommends the initiation of LDA in SLE patients at the beginning
of first trimester in order to preclude or delay the onset of gestational
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hypertension in pregnancy. LDA is also safe in pregnancy as it shows
no significant foetal outcomes e.g. small gestational age, intrauterine
growth restriction or preterm delivery in patients taking LDA compared
with those without LDA. 115, level II-2

Refer to Appendix 7 for use of SLE medication in pregnancy and
lactation.

• The CPG DG opines that all SLE patients who are pregnant especially
those with positive aPL should be referred to the rheumatologist at
antenatal booking.
• All pregnant SLE patients should be under combined care of
rheumatologist/physician, feto-maternal specialist/obstetrician and
family medicine specialist.
• Calcium supplementation is essential in pregnant SLE patients for
pre-eclampsia prophylaxis.

Recommendation 13
• The following medications should be continued in systemic lupus
erythematosus (SLE) with pregnancy:
 hydroxychloroquine
 azathioprine
 calcineurin inhibitors
 low dose corticosteroids
• Low dose aspirin should be initiated in all pregnant SLE patients
unless intolerance or contraindicated.

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