Treating Lupus Nephritis During Pregnancy

It is somewhat controversial whether or not pregnant women with lupus experience flares more frequently than their non-pregnant counterparts.  Regardless, however, the issue of a lupus flare in a pregnant patient is not uncommon, especially considering that the disease tends to affect young females.

In general, the mainstays of treatment for lupus flares during pregnancy are AZATHIOPRINE and STEROIDS; both have had a pretty good track record for safety in pregnancy.  Low-dose cyclosporin A may also be a consideration, and for patients in whom there is evidence of anti-phospholipid antibody syndrome, clot prophylaxis should be initiated with aspirin or low-molecular weight heparin.  

Drugs specifically to be avoided in lupus pregnancies are CYCLOPHOSPHAMIDE (which unequivocally causes birth defects, especially during the 1st trimester) and MYCOPHENOLATE MOFETIL (which recently has been shown to result in ear and other facial malformations such as cleft lip and cleft palate).