ABSTRACT
Pregnancy is associated with an alteration in the maternal immune system. There is a shift away from cell-mediated immunity to humoral immunity. Pregnant women taking steroids are at increased risk of gestational diabetes, infection and preterm rupture of the membranes. Supplementary calcium and vitamin D are important in women with connective tissue disease, particularly those receiving steroids. Azathioprine is a commonly used immunosuppresive drug for the treatment of autoimmune disease including SLE and is safe to use in pregnancy. This is partly because the fetal liver lacks the enzyme that converts azathioprine to its active metabolites. Azathioprine may be added in pregnancy and is useful as a steroid-sparing agent, although its onset of action is at least 3 weeks. The risk of congenital collagen defect is about 5% and therefore it should be stopped pre-pregnancy in women with rheumatic diseases.
