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SLE Pre-Conception Planning — SCE Rheumatology MCQ

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HardSLE & Antiphospholipid SyndromeSLE Pre-Conception PlanningSCE Rheumatology

A woman with lupus nephritis taking mycophenolate plans pregnancy. Disease is stable and azathioprine was previously tolerated. What is the safest pre-conception strategy?

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Correct answer: E — Stop mycophenolate, use effective contraception for at least 6 weeks and establish disease control on a pregnancy-compatible alternative

Mycophenolate is teratogenic and must be stopped before conception, with effective contraception continued for at least 6 weeks after stopping. A pregnancy-compatible alternative such as azathioprine should be established while confirming durable disease control; active lupus nephritis itself poses substantial maternal and fetal risk.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions