Is it safe to try for pregnancy with lupus nephritis?

Question

Hello doctor,

My cousin has lupus nephritis, and we are very concerned because she and her husband are planning to have a child soon. Her kidneys are currently stable on immunosuppressants, but we are unsure what this means for pregnancy risks.

Is it safe to try for pregnancy with lupus nephritis in remission, or is IVF (in-vitro fertilization) safer?
Could hormonal changes during conception or pregnancy trigger a flare?
How does lupus nephritis affect the chances of miscarriage or preterm delivery?
Also, are drugs like Mycophenolate or steroids safe to continue during pregnancy, or will they need to be switched before conception?
She has irregular periods and painful cramps. Could this be related to lupus?
Should she avoid hormonal contraceptives like pills or IUDs (intrauterine devices) in case they trigger flares?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Lupus nephritis and pregnancy can be a tricky combination, but with proper planning, it is not impossible. The key thing is timing. Pregnancy is only considered safe if the disease has not been in remission for at least six months and kidney function is stable. It sounds like she is there, but let us go step by step.

Lupus nephritis affects the kidneys and makes pregnancy riskier because the immune system can flare up, and the kidneys can take a hit. Hormonal shifts during conception or pregnancy can trigger flares, especially if the disease is not well-controlled before trying.

Do kidney function tests, autoantibodies (anti-dsDNA (anti-double-stranded DNA), complement levels (C3, C4), antiphospholipid antibodies, hormone profile, and pelvic ultrasound. The differential diagnosis is irregular periods. They can occur due to lupus or medications, especially immunosuppressants, and painful cramps might be related to endometriosis or hormonal imbalance.

The probable diagnosis is lupus nephritis in remission with fertility concerns. Natural pregnancy is possible, but only if her nephrologist and rheumatologist say she is stable enough. IVF is not necessarily safer unless there are separate fertility issues. Mycophenolate mofetil is not safe in pregnancy. It needs to be stopped and switched to something safer, like Azathioprine, at least three months before trying to conceive.

Steroids can be continued in low doses during pregnancy if needed to keep lupus under control. There is a higher risk of miscarriage, preterm birth, and preeclampsia, especially if lupus flares up or kidneys worsen during pregnancy. So it is a high-risk and needs tight monitoring. She will require regular check-ups during pregnancy, such as laboratory tests, ultrasounds, BP (blood pressure), and urine protein.

Plan pregnancy during a remission phase only. Switch unsafe medications before trying. Avoid hormonal contraceptives if lupus is hormone-sensitive or if she has had clots, especially if antiphospholipid syndrome is positive. Use safer options that include a non-hormonal IUD (intrauterine device) or barrier method. Regular follow-ups should be made. Have regular follow-ups with a nephrologist, rheumatologist, and OBG (obstetrician and gynecologist) during pregnancy planning.

Get her current medication list, recent laboratory results, and whether she has been tested for antiphospholipid antibodies. That will help decide how soon and safely she can try. She must not stop or switch any medications without consulting her specialist.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.