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Hi every one I am Ann new to this site and I am looking for friends who can give me some advice on the difficult situation I am facing. I was diagnosed Lupus 6 years ago, I was taking 30mg imuran, 3mg prednisone, and 300mg Plaquenil per day before I got pregnant. I have been pregnant for 8 weeks. My lupus doctor does not seem a very good doctor, he did not tell me I should stop the imuran six months before pregnant. When he found out I was pregnant, he told me imuran would cause all kinds of problems. Me and my husband are desperate and thinking about an abortion because we don’t want the baby to suffer. When we told the doctor about the abortion, he changed his tone and said the baby might be fine. He told me to stop the imuran and plaquenil, and increase the prednisone to 5mg. At this point, the lupus doctor does not have much creditability to us. We really worry about the health of our baby because I was taking 30mg when I was pregnant at the first 30 days. I don’t know if I should take the risk to keep the baby or abort the baby? If something happen to the baby, I will be guity all my life. Thanks so much.
 

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Hello and welcome :)

Pregnancy isn't really my good subject as I became ill following pregnancy but I am rather shocked at the answers you have been getting :eek:

Although many doctors, just to be sure, would "prefer" you not to be on imuran during pregnancy it can sometimes be used if it is considered necessary to stay on imuran for the patient's well-being.

Obviously such a pregnancy needs careful follow up and you should be seeing a high risk ob-gyne with lupus experience. He may decide that you need to stop imuran but stopping plaquenil is generally considered a very bad move. As it takes months to kick in it can push you into a major flare following the birth and that is really not a time that you need that to happen.

I'm a little confused that you are taking 30mg of of imuran - I thought that the lowest tablets were 50mg?? If you are on either 30 or 50 mg it is also an extremely LOW imuran dose and I certainly wouldn't be worried about your baby right now.

You need to get in touch with an informed doctor. I don't know where you are but there are specialist lupus pregnancy clinics and I think it would be worth traveling a little further and being sure of the advice you are given.

all the best,
Katharine

P.S. I deleted the duplicate post you made in the other thread as it is older and you are unlikely to get answers on it. It's good that you read that thread, I hope you found it reassuring.
 

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Hi,

Welcome, and congratulations on your pregnancy!

I agree with Katharine that you need to see a doctor - preferably an obstetrician for some good advoce about your pregnancy and medications.

Your lupus doctor seens to be out of date. It is well recognised now that both plaquenil and immuran (azathioprine) are quite safe to take during pregnancy and breastfeeding, and that the benifit of well controlled lupus is greater than any potential risk the medications pose.

I take 150mg azathioprine and 300mg plaquenil and am also 8 weeks pregnant. I am not going to stop or reduce either of these meds. This has been decided in conjunction with both my rheumy and obstetrician, so I am quite happy that it is a good decision.

You certainly don't need to abort this pregnancy just because of the immuran. The studies about malformations were done on mice, and there is no evidence that the same applies to humans. And there are literally thousands of healthy babies born to mums who took immuran in pregnancy.

I hope this reasures you,

Take care, Cath
 

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Welcome to the forum to you and your husband.

I am so sorry about the distressing situation you find yourselves in.

I hope very much that you can urgently find a competent lupus expert who is up to date on pregnancy and lupus and what medications are OK.

Most lupus pregnancies count as high risk even if the mother is not particularly ill with serious isssues such as kidney disease or a history of strokes. A high risk obstretrician/gynecologist is usually involved in care simply because there is a higher risk of complications in lupus pregnancies.
Although problems are by no means inevitable, being in the care of a specialist means that if there are any, they will be sooner detected and get expert treatment with the minimum of delay.

First, some facts. There is vast knowledge of actually using Plaquenil and Imuran in pregnancies because they have been used for many years now for other purposes, antimalarial prophylaxis and very commonly in lupus, and the AZA/ Imuran use for transplants.

Plaquenil is in the FDA Category C which is " Animal studies show teratogenic [fetal deformity], embryocidal or other fetal effects and there are no controlled studies in women or there are no studies in women or animals. Category C drugs should only be given if the benefit outweighs the potential fetal risk"

No controlled studies have been done because it would be unethical to conduct studies of this sort and risk damaging babies. In practice these days, Plaquenil is continued during pregnancy because it has shown no adverse effects specifically atttributable to it, only benefits in keeping the lupus down and thus reducing the risks of lupus related complications.

Plaquenil takes a long time to leave the system and a long time to work as well so in view of the very low risks if any, none of the top specialists insist on it being stopped if a woman falls pregnant while on it. It might be suggested that the dosage be reduced all depending on the woman's health, history, her preferences and the doctor's opinion.

A survey of 52 lupus experts from North America and the UK showed that 69% continue anti- malarial treatment sometimes, often or always in pregnancy, and 63% continue Plaquenil in the post- partum period and advise breast feeding.
There have been various studies done, for example with some women taking placebos. The rate of congenital deformation was no higher than in the healthy general population and none of them could be attributed specifically to the Plaquenil. Various follow ups, for example to 26 months showed no abnormalities. Flares of lupus occured more often in women on placebos, 2.5 - fold and severe flares 6.1 - fold
(Quotes and info from Dubois p1021)


Azathioprine / Imuran is in FDA Category D. This is defined as
" There is evidence of human fetal risk, but benefit in use in pregnant women may be acceptable in spite of risk ( i.e. in life threatening or serious disease "

Similar observations have been made about using azathioprine in pregnancy, IE that there wasn't a greater incidence of abnormalities than in the general population and there has been no particular pattern to them.

My personal take would be that I would not end my pregnancy simply because of taking those medicines. You are on 3/4 of the usual dose of Plaquenil and a pretty low dose of AZA. The fact that abnormalities reported are no higher than those found in general and no particular pattern as one would expect with drug caused congenital problems, would be very significant to me.

I would take that risk, but others might prefer to try first to follow the ideal path of being drug free for 6 months with stable disease.

I feel I should say that there there are some circumstances in which I might with utmost regret decide to terminate an unplanned pregnancy. My general poor health might be one of them, especially for example if I was already finding it difficult having to work to make ends meet and had no help to count on with child rearing. Or if I had got pregnant while taking a drug known to cause deformities. I have taken two of those although one was post menopausal but the doctors made is very clear that termination would have to be envisaged and there was insistence on two means of BC.

Feeling that I didn't have the best possible health care might be another weighty factor. This doctor has shown himself to be an ignorant, insensitive boor. He has no business treating women with lupus.

You should immediately get all your records and test results from your doctor for your own information and for when you change doctors.

See if you have been tested for anti Ro antibodies. Very rarely these can cross the placenta and cause some temporary problems. Even more rarely these antibodies can cause permanent heart block. Special scans between 16 and 24 (?) weeks can show if problems are occuring and arrangements made for the baby's care as soon as she is born.

All the very best and many hugs

Clare




 

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I would seek out another rheumy and a high risk obstetrician. Most women who need Imuran to control their lupus will stay on it while pregnant; and the evidence seems to be accumulating the Imuran is pretty safe to take in humans especially at the low doses lupus patients take. You have to realize that the animal studies that are done looking for problems usually use doses that are MUCH higher than the highest human dose used; furthermore lupus doses are lower than for organ rejection prevention.

Ultimately this decision is up to you, and I'm glad to hear your doctor changed his tune a little bit when he realized his talk had made you start thinking about terminating the pregnancy. Gather as much information as you can and make the decision that is best for you considering all your circumstances, not just medication questions. You'll also need to weigh how you'll be able to handle things emotionally under both of the negative possibilites (baby born with problems versus terminating a healthy baby).

Personally, I believe your chances of a healthy baby are pretty good. Especially if you've been eating well/getting enough folate. :)
 
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