Aspirin Pre-eclampsia Prevention SLE — ESENeph MCQ

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ModeratePregnancy & RenalAspirin Pre-eclampsia Prevention SLEESENeph

A 38-year-old woman with SLE and antiphospholipid syndrome is pregnant at 12 weeks. She has lupus nephritis in remission on Azathioprine and Hydroxychloroquine. She is also on low-dose Aspirin and LMWH for APS. According to NICE NG133, what additional intervention reduces pre-eclampsia risk?

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Correct answer: B — Low-dose Aspirin from 12 weeks (she is already on this) – ensures it was started by week 12 for optimal pre-eclampsia risk reduction

This patient is at high risk of pre-eclampsia because she has autoimmune disease (SLE and antiphospholipid syndrome) and a history of renal disease/lupus nephritis. NICE NG133 recommends that pregnant women at high risk of pre-eclampsia take low-dose aspirin 75–150 mg daily from 12 weeks of gestation until birth. Therefore, the additional pre-eclampsia risk-reduction intervention is to ensure low-dose aspirin has been started by 12 weeks and continued. LMWH is appropriate for APS-related thrombosis/pregnancy morbidity risk but does not replace aspirin for pre-eclampsia prophylaxis. Plasma exchange, IV immunoglobulin, calcium alone, and high-dose prednisolone are not NICE-recommended routine interventions to reduce pre-eclampsia risk in this scenario.

Reference: NICE Guideline NG133: Hypertension in pregnancy: diagnosis and management, recommendations 1.1.2–1.1.3, updated 2023. https://www.nice.org.uk/guidance/ng133/chapter/recommendations