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14 weeks pregnant, SLE patient. Taking HCQ tablets. Ultrasound scheduled. Is the baby safe?

Dear sir, My Sister 26y is pregnant with 14 weeks.She is under treatment for SLE since 3years.Her Blood Test for ANA is 151(Normal range below 20). She is taking Tablet HCQ.Now Doctor has advised Sonography to check baby s heart .Our concern is, whether she or her baby is safe?Can she deliver without nay defects to baby?
Asked On : Sat, 5 Jan 2013
Answers:  1 Views:  25
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OBGYN 's  Response
Mar 2013
Thanks for your query.
SLE increases the risk of spontaneous abortion, intrauterine fetal death, preeclampsia, intrauterine growth retardation, and preterm birth. Prognosis for both mother and child are best when SLE is quiescent for at least 6 months before the pregnancy and when the mother’s underlying renal function is stable and normal or near normal. Currently, more than 50% of all pregnancies in women with lupus have a normal outcome. About 25% of women with lupus deliver healthy babies prematurely. Fetal loss due to spontaneous abortion occurs in fewer than 20% of cases. Patients with SLE may have increased rates of emergency or cesarean delivery secondary to flares of renal disease or preeclampsia.
An increase in fetal mortality rates is seen in women who have Ro/SSA or La/SSB antibodies present, secondary to fetal heart block.
In a prospective study, hypertension during pregnancy, preterm delivery, unplanned cesarean delivery, postpartum hemorrhage, and maternal venous thromboembolism were more common in women with SLE than in women without SLE. In addition, fetal growth restriction/ retardation and neonatal deaths were most often seen in association with SLE.

The mother’s health and fetal development should be monitored frequently during pregnancy. In addition, an obstetrician with experience in high-risk care should conduct the follow-up of pregnant women with SLE.
A rheumatologist, an obstetrician experienced with high-risk care, and a nephrologist (if renal disease present or if it develops later) should work as a team to care for a pregnant patient with systemic lupus erythematosus (SLE).
None of the medications used in the treatment of systemic lupus erythematosus (SLE) is absolutely safe during pregnancy. Hence, whether to use medications should be decided after careful assessment of the risks and benefits in consultation with the patient. During the first trimester, most of the drugs should be avoided.
Take care.
Answered: Sat, 5 Jan 2013
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