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Counsel on Increased Risk with Pregnancy
- Lupus may increase the risk of these problems during pregnancy:
- Preeclampsia
- Premature birth
- Miscarriage
- Stillbirth
- Lupus flares
- Maternal death in women with lupus-related end organ damage
- Women in remission or who have lupus under control for at least 6 months prior to pregnancy are less likely to have complications during pregnancy.
- Some babies born to mothers with lupus may have neonatal lupus.
- Lupus may increase the risk of these problems during pregnancy:
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Management
- Carefully consider pros/cons of continuing potentially teratogenic medications used to treat lupus (e.g. methotrexate, plaquenil).
- Postponing pregnancy until lupus is well controlled may improve pregnancy outcomes.
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Contraception Counseling
- Levonorgestrel IUD or hormone implant are preferred, given prevalence of anemia and thrombophilia.
- With thrombocytopenia or anemia, risks of copper-T-IUD likely outweigh benefits.
- If patient has antiphospholipid antibodies, avoid estrogen containing contraceptives. Risks of pregnancy outweigh risks of progesterone-only contraceptives (implant, shot, LNG-IUD, and progestin-only pill).