How a Multidisciplinary Approach in Kerala Is Changing Outcomes
For the millions of women worldwide living with systemic lupus erythematosus (SLE), the decision to pursue pregnancy has historically been fraught with uncertainty and fear. Recent advances in protocol-based, multidisciplinary care are transforming what was once considered high-risk into a journey filled with greater confidence and hope.
Understanding the risks and complications
Research indicates that approximately 25.6% of pregnant lupus patients experience a disease flare during pregnancy, with renal and hematologic complications being particularly common 1 .
A team-based model for better outcomes
Manage lupus activity and medication adjustments
Monitor maternal and fetal well-being
For patients with kidney involvement
Plan for the baby's care after delivery
Provide ongoing patient support and coordination
Address the significant emotional challenges
A critical component of success lies in preconception counseling and planning. Experts recommend that women have their lupus under good control for at least six months before conceiving 6 .
Evaluate lupus activity and stability
Adjust medications for pregnancy safety
Screen for antiphospholipid, anti-Ro, and anti-La antibodies
Establish baseline blood pressure, renal function, and serologic markers
Plan pregnancy during disease remission
Essential components of successful lupus pregnancy care
For all lupus pregnancies (unless contraindicated)
Reduces pre-eclampsia riskContinuation throughout pregnancy
Prevents disease flaresFor patients with antiphospholipid antibodies
Prevents blood clotsCarefully dosed for disease flares
Controls disease activityTreatment plans for specific scenarios
Addresses complicationsFor growth restriction detection
Ensures fetal well-beingKey interventions in lupus pregnancy management
| Intervention | Function | Timing/Special Considerations |
|---|---|---|
| Hydroxychloroquine | Prevents disease flares; may reduce anti-Ro related heart block | Continue throughout pregnancy |
| Low-dose Aspirin | Reduces pre-eclampsia risk; antiphospholipid antibody management | Start at 12 weeks; earlier in high-risk |
| Low Molecular Weight Heparin | Prevents blood clots in antiphospholipid syndrome | Throughout pregnancy and postpartum |
| Corticosteroids | Controls disease activity | Lowest effective dose; monitor for side effects |
| Azathioprine | Steroid-sparing agent for active disease | When necessary for disease control |
| Monthly Ultrasounds | Monitors fetal growth and well-being | From 18-20 weeks onward |
| Biophysical Profiles | Assesses fetal well-being | Weekly from 26-32 weeks in high-risk cases |
Based on data from systematic reviews and clinical guidelines 1 4
The implementation of specialized, multidisciplinary protocols has demonstrated significant improvements in pregnancy outcomes for women with lupus.
Promising developments in lupus pregnancy care
The success of protocol-based, multidisciplinary care for lupus pregnancies in Kerala reflects a broader global recognition that complex medical conditions require collaborative, systematic approaches.
The integration of telemedicine platforms is expanding access to specialized multidisciplinary care for patients in remote areas, allowing coordination between local providers and specialist centers 8 .
The landscape of lupus and pregnancy has transformed dramatically in recent decades. From a time when women with lupus were routinely advised against pregnancy, we have moved to an era where most women with lupus can successfully carry a pregnancy with proper care.
Through the careful application of protocol-based, multidisciplinary care—exemplified by the work in Kerala, South India—the goal of a healthy mother and baby becomes an achievable reality for the vast majority of women living with this challenging autoimmune condition.