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How to manage pregnancy during SLE?

Q: I am a 26 years old female. I am suffering from SLE. The problem started last year. I had to terminate my first pregnancy in because I was in a bad condition and my problem wasn't diagnosed till then. Since my diagnosis, I have been taking the following medicines under the supervision of a nephrologist. Mycofit-S 360, twice daily; Omnacortil - 10 mg, once daily; Ostocalicium Forte, twice daily; ZInetac - 150 mg, twice daily. Initially I started with Omnacortil at 60 mg per day which lead to a sudden increase in diet intake and weight. My current doctor has not guided me satisfactorily on many issues. My initial problems were, urine infection (RBC cells in urine), rashes on face, hair loss all over body and pain in joints. My immunity is being suppressed by drugs and my doctor says that taking anti Hepatitis - or typhoid injections during SLE treatment will solve no purpose. How do I save myself form such infections? My gums have started bleeding. What are the things that I have to keep in mind before and during pregnancy? Can SLE be transmitted to the unborn during pregnancy?

A:Lupus erythematosus (LE) is a chronic auto immune inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, and kidneys. Normally, the body's immune system makes proteins (antibodies) to protect us against viruses, bacteria, and other foreign materials (antigens). In an auto immune disease the immune system loses its ability to tell the difference between foreign antigens and its own antigens (cells and tissues) and starts making antibodies directed against self antigens. These auto-antibodies, react with the body’s tissues leading to inflammation and injury. There are three types of lupus: discoid (limited to the skin), systemic (affecting almost any organ system of the body), and drug-induced (occurring after the use of certain prescribed drugs). There is no single laboratory test to diagnose this condition and a set of criteria has been described for its diagnosis. An individual needs to have four or more of these symptoms (not all occurring at the same time) to suspect lupus. Commonly used blood tests for diagnosis include: Anti-nuclear antibody test (ANA) to determine auto antibodies to cell nuclei; Anti-DNA antibody test to determine if there are antibodies to the genetic material in the cell; Anti-Sm antibody test to determine if there are antibodies to a ribonucleoprotein found in the cell nucleus; Serum complement estimation to determine the total level of a group of proteins which can be consumed in immune reactions and determination of Complement proteins C3 and C4. Kidney disease (lupus nephritis) is one of the most serious manifestations of SLE and is usually seen within 5 years of diagnosis. The main aim of treatment is to normalize renal function or try to prevent the progressive loss of renal function. The treatment of the disease depends on the organ/system involved. While most systemic symptoms respond to hydroxychloroquine and non-steroidal anti-inflammatory medications, immunosuppressive therapy (steroids and cyclophosphamide) may be required for kidney or brain involvement. No diet-based treatment of SLE has been proven effective. Patients on immunosuppression are prone to opportunistic infections while high-dose steroids may cause osteonecrosis. Premature atherosclerosis and myocardial infarction are other possible complications. Women suffering from SLE have a higher rate of spontaneous abortion, premature labour, and intrauterine death. The disease should be well controlled for at least 4 months prior to conception to minimize complications. The likelihood of the disease flaring up after delivery is higher. If mother’s have SSA/Ro antibodies, the likelihood of the bay suffering from neonatal lupus is higher. You need to consult a rheumatologist and can do so at the All India Institute of Medical Sciences, Sir Ganga Ram Hospital, Indian Spinal Injuries Centre, Apollo Hospital etc.

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