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SLE Pre-Conception Planning — RACP Adult Medicine MCQ

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ModerateRheumatologySLE Pre-Conception PlanningRACP Adult Medicine

A 38-year-old woman with known SLE and anti-Ro/anti-La antibodies is planning pregnancy. She is currently on mycophenolate mofetil and hydroxychloroquine. Her disease has been in remission for 12 months. What medication changes are needed pre-conception?

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Correct answer: B — Stop mycophenolate and switch to azathioprine; continue hydroxychloroquine

Mycophenolate mofetil is teratogenic (FDA category D) and must be stopped ≥6 weeks before conception. Azathioprine is the preferred steroid-sparing agent in pregnancy for SLE (safe in pregnancy, FDA category D reclassified as compatible). Hydroxychloroquine must be continued — it reduces flare risk in pregnancy and may reduce the risk of congenital heart block in anti-Ro positive mothers.

Reference: EULAR – 2024 – SLE in Pregnancy; eTG Rheumatology 2024; TGA 2024