Table 1.

Preconception to postpartum: managing lupus nephritis during maternal transition.

Stage	Recommendations
Preconception	- Conceive during a period of stable disease remission, preferably for at least 6 months. - Perform a thorough evaluation of disease activity and organ involvement. - Ensure SLE and LN are in remission or low activity; consider the SLEDAI score. - Test for anti-dsDNA antibodies and complement levels if there is an active disease or a history of flares. - Be aware of C4 levels as a risk factor for SLE flare and low C3 levels as a potential risk for preterm delivery.
During Pregnancy	- Advise on the likelihood of preterm delivery and increased risk of operative delivery. - Monitor LN activity closely with regular nephrologist assessments, more frequently in active SLE. - Conduct fetal echocardiography for anti-Ro/SSA and/or anti-La/SSB positive patients. - Differentiate between LN flare and preeclampsia; initiate therapy upon diagnosis of LN flare. - Be vigilant for preeclampsia development after 20 weeks of gestation in SLE patients. - Implement tailored maternal-fetal monitoring strategies, including frequent ultrasounds and fetal testing.
Postpartum	- Monitor for LN flare and thromboembolic events within the first six months post-delivery. - Encourage breastfeeding, discussing the safety of medications during lactation. - Follow-up closely postpartum, using prophylactic low-molecular-weight heparin for at-risk women. - Consider treatment adjustments for severe lupus or lupus nephritis, especially in cases of premature delivery.