Question
Which of the statements below is not accurate regarding lupus nephritis during pregnancy?
| A. |
Immunosuppression can be continued during pregnancy
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| B. |
Ecosprin, methotrexate, cyclophosphamide, corticosteroids, azathioprine are safe in pregnancy
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| C. |
Pregnancy to be planned once the disease has been quiescent for at least 6 months and there is no evidence of renal dysfunction
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| D. |
High dose corticosteroids for lupus flare in pregnancy is safe
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Show Answer
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Correct Answer » B
Explanation
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Lupus nephritis is a serious complication of systemic lupus erythematosus (SLE) that can affect pregnant women. Proper management of lupus nephritis in pregnancy requires careful consideration of medication safety for both the mother and the fetus.
Inaccuracies in the Statement:
Methotrexate and cyclophosphamide are not safe during pregnancy:
- Methotrexate: This is a known teratogen and is contraindicated during pregnancy due to its association with fetal malformations, such as neural tube defects and limb abnormalities.
- Cyclophosphamide: This drug is also contraindicated during pregnancy, as it can cause fetal toxicity, congenital abnormalities, and even fetal loss.
Other Medications:
- Ecosprin (low-dose aspirin) and corticosteroids are generally considered safe during pregnancy and are often used in women with SLE to reduce the risk of preeclampsia or to manage lupus flares.
- Azathioprine: This immunosuppressive drug is considered safe in pregnancy and is often used in women with lupus nephritis to maintain disease control.
Explanation of Other Options:
Immunosuppression can be continued during pregnancy: This is true, but only specific immunosuppressive medications (like azathioprine and corticosteroids) are safe. Methotrexate and cyclophosphamide should be avoided.
Pregnancy to be planned once the disease has been quiescent for at least 6 months: This is correct. Planning pregnancy when lupus nephritis is quiescent and there is no evidence of renal dysfunction significantly improves maternal and fetal outcomes.
High dose corticosteroids for lupus flare in pregnancy is safe: This is also accurate. Corticosteroids, including high-dose prednisolone, are often used to manage lupus flares during pregnancy and are considered safe when necessary.
