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SLE in pregnancy — SCE Rheumatology MCQ

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HardPregnancy and rare rheumatic diseaseSLE in pregnancySCE Rheumatology

A woman with SLE has been clinically quiescent for eight months on hydroxychloroquine and plans pregnancy. Anti-Ro/La and antiphospholipid status are unknown; urinalysis is currently normal. What should preconception review include?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Hydroxychloroquine continuation plus renal, anti-Ro/La and aPL assessment

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · B = shown as D · A = shown as E

C is correct. Pregnancy planning in SLE occurs during stable disease and includes medication compatibility, renal function and urine protein baseline, blood pressure, anti-Ro/La and antiphospholipid antibodies. Hydroxychloroquine is continued because withdrawal increases flare risk. A stops a compatible protective drug and chooses a non-informative ANA trend. B introduces a teratogen. D tests unrelated markers. E overinterprets a single dipstick and loses the baseline needed to distinguish flare from pre-eclampsia later. Results determine fetal rhythm, thromboprophylaxis and maternal surveillance plans.

Reference: BSR guideline on prescribing immunomodulatory drugs in pregnancy and breastfeeding: https://academic.oup.com/rheumatology/article/62/4/e48/6783012