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SLE in Pregnancy — RACP Adult Medicine MCQ

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ModerateRheumatologySLE in PregnancyRACP Adult Medicine

A 35-year-old woman with SLE and nephritis on mycophenolate and hydroxychloroquine is planning pregnancy. What is the appropriate medication management?

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Correct answer: C — Cease mycophenolate pre-conception and switch to azathioprine; continue hydroxychloroquine

Mycophenolate is teratogenic (Category D – causes ear, limb, cardiac, and facial malformations) and must be ceased at least 6 weeks before conception. Azathioprine is the safest immunosuppressive for maintaining lupus nephritis remission during pregnancy (Category D but extensive safety data). Hydroxychloroquine should be CONTINUED throughout pregnancy – cessation increases the risk of lupus flare, and it has demonstrated safety in pregnancy with reduced neonatal lupus risk.

Reference: eTG – 2025 – Rheumatology; ARA – 2024 – Lupus and Pregnancy Position Statement