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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.

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