In lupus, Imuran can reduce damage to joints, decrease the risk for disability, and improve conditions in cases where lupus affects the kidneys (lupus nephritis) or liver. Anti-Ro/SSA antibodies are associated with an increased risk of congenital heart block (1%–2%), neonatal lupus, and laboratory abnormalities, including hematologic (thrombocytopenia and neutropenia) and hepatic abnormalities (elevated transaminases), in asymptomatic infants within the first 27 days of life (26,27). Active nephritis was associated with an increased risk of hypertension in pregnancy, whereas both active nephritis and a history of nephritis conferred increased risks of hypertension and pre-eclampsia compared with SLE patients without histories of LN (41). Clinical remission of SLE activity and careful control of the disease are associated with improved outcomes, underlying the importance of careful monitoring of these patients throughout pregnancy (28–30). Therefore, anticoagulation is indicated for all SLE patients positive for antiphospholipid antibodies and a history of thrombotic event(s), regardless of whether they were receiving anticoagulation before pregnancy. NIH I believe they used to think it could be toxic but have since found no increased risk in studies. No infant had major congenital abnormalities. This pilot study aimed to determine whether SLE therapy during pregnancy was associated with developmental delays in offspring. What it is: Azathioprine or the brand name Imuran, is a drug that was originally developed to prevent organ rejection in people who had received a donor transplant. ... and neonatal lupus (NL) syndromes are seen in lupus pregnancy. during pregnancy in renal transplant recipients and patients with systemic lupus erythematosus, opin- ions vary whether it should be continued in preg- nancy in inflammatory bowel disease. As a result, the US Food and Drug Administration (FDA) assigned azathioprine to category “D.” Data regarding the use of azathioprine in pregnancy complicated by SLE are limited to one cohort of 31 pregnancies. 2002 May;65(5):240-61 2016 Oct;36(10):1431-7. doi: 10.1007/s00296-016-3525-0. These considerations present challenges that underscore the importance of a multidisciplinary team approach when caring for these patients, including a nephrologist, rheumatologist, and obstetrician who have experience with these pregnancy-related complications. Given the additional concerns related to the developing fetus, consideration must be given to the pregnancy-related safety and efficacy of the medications commonly used to manage LN (Table 2). Patients with SLE have fewer Tregs that also are functionally defective, which may confer increased risks for pre-eclampsia and maternal and fetal morbidity (10). Publication date available at www.cjasn.org. 1 mg/kg/day IV/PO initially in single daily dose or divided q12hr; after 6-8 weeks, increase by 0.5 mg/kg/day every 4 weeks; not to exceed 2.5 mg/kg/day. Systemic activity of SLE must be assessed, with careful attention to renal involvement. The UK-BIOGEAS Registry: Efficacy of rituximab in 164 patients with biopsy-proven lupus nephritis: Pooled data from European cohorts [published online ahead of print October 18, 2011]. Recent studies have reported more favorable outcomes, and patients are seldom counseled against pregnancy (5,6). Although progressive renal impairment may occur, it is generally mild, and ESRD requiring hemodialysis is rare, even in patients with active LN (14). These pregnancies should be monitored by fetal cardiac auscultation, echocardiography, and neonatal electrocardiography after delivery (49). The Hopkins Lupus Pregnancy Center experience, Problems associated with the management of pregnancies in patients with systemic lupus erythematosus, A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis, The effect of lupus nephritis on pregnancy outcome and fetal and maternal complications, Pregnancy in past or present lupus nephritis: A study of 32 pregnancies from a single centre, Pregnancy outcome in women with pre-existing lupus nephritis, Maternal and fetal outcome of lupus pregnancy: A prospective study of 29 pregnancies, Maternal and foetal outcomes in pregnant patients with active lupus nephritis, Maternal deaths in women with lupus nephritis: A review of published evidence [published online ahead of print February 6, 2012], Spectrum and progression of conduction abnormalities in infants born to mothers with anti-SSA/Ro-SSB/La antibodies, Immunology and clinical importance of antiphospholipid antibodies, Association of anticardiolipin antibodies with preeclampsia: A systematic review and meta-analysis, Laboratory classification categories and pregnancy outcome in patients with primary antiphospholipid syndrome prescribed antithrombotic therapy, Lupus and pregnancy: Ten questions and some answers, Lupus nephritis: A clinical review for practicing nephrologists, Factors associated with poor outcomes in patients with lupus nephritis, Class III-IV proliferative lupus nephritis and pregnancy: A study of 42 cases, Biomarkers for lupus nephritis: A critical appraisal, Biomarkers for lupus nephritis: The quest continues, Anti-C1q antibodies have higher correlation with flares of lupus nephritis than other serum markers, Renal biopsy during pregnancy: ‘To b … or not to b …?’, Renal biopsy in pregnancies complicated by undetermined renal disease, The role of renal biopsy in women with kidney disease identified in pregnancy, Hazards of oral anticoagulants during pregnancy, Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition), EBPG Expert Group on Renal Transplantation: European best practice guidelines for renal transplantation, Section IV: Long-term management of the transplant recipient. 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