SLE - Rx & effects

Maternal effects :
- Treatment with cyclophosphamide may lead to premature ovarian failure and infertility

- Increased risk of hypertensive disorders: Pre-eclampsia occurs in ~15% of women and may be difficult to distinguish from lupus nephritis

- Increased risk of UTI

- Increased risk of gestational diabetes

- VTE – risk especially increased in women with anti-phospholipid antibodies. 

1. Women already on warfarin should be switched to therapeutic LMWH as soon as the pregnancy is recognized. 
2. Women with antiphospholipid syndrome but no previous VTE should be treated with prophylactic LMWH and low-dose aspirin during subsequent pregnancies. 
3. Women with SLE + antiphospholipid antibodies but no past morbidity can be managed with low-dose aspirin +/- hydroxychloroquine.