Treatment of Systemic Lupus Erythematosus (SLE) in Pregnancy

Purpose of review To identify known teratogenic medications that may be used to treat SLE and discuss alternative therapeutics that can be used throughout pregnancy in order to manage maternal autoimmune diseases. Recent findings Teratogenic immunosuppressive medications include methotrexate, mycophenolatemofetil, and cyclophosphamide. In anticipation of pregnancy, such medications should be discontinued and replaced with immunosuppressive medications including azathioprine and cyclosporine and assessed for disease stability. Summary Pregnancy is an important aspect to women’s lives, and a diagnosis of SLE should not necessarily preclude the ability to bear children. Pregnancy outcomes among SLE women are favorable when disease is well controlled prior to conception and teratogenic medications are avoided. Several immunosuppressive therapies that are compatible with pregnancy are available to treat flares that may occur during pregnancy. Hydroxychloroquine use throughout pregnancy is associated with improved outcomes for both mother and infant. Risks of medication use need to be balanced with risks of active maternal disease.