Medicine Matters rheumatology

a. She should not become pregnant at all because she has SLE, a chronic systemic inflammatory disease associated with high risk of adverse pregnancy outcomes, namely fetal loss, intra-uterine growth restriction, preterm delivery, small for gestational age and pre-eclampsia.

b. She should not become pregnant because although her SLE is in remission, she has triple positivity for aPL antibodies, so has a high risk of experiencing a thromboembolic event and pregnancy loss.

c. She may become pregnant because her disease has been in sustained remission for more than 12 months, and she has no relevant comorbidities. However, first she must stop teratogenic drugs and replace them with others that are compatible with pregnancy. Ideally her pregnancy should be managed in a multidisciplinary setting with close obstetric and rheumatologic monitoring.

d. She should not become pregnant because she tested positive for anti-Ro/SSA antibodies, which can cross the placenta after the second trimester leading to congenital heart block in the neonate.

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