Is it safe to treat a flare of systemic lupus erythematosus during the first trimester of pregnancy?
—Abul Rahman, MD, Gulfport, Miss.

A lupus flare during the first trimester should be treated, although some medications, such as cyclophosphamide, and experimental regimens should be avoided. Corticosteroids are the best therapy. These agents are weak teratogens (one to two facial clefts/1,000 exposures), but they remain first-line therapy, even in the first trimester. Failure to control the disease early in pregnancy predisposes the patient to pre-eclampsia and premature birth.
—Daniel R. Mishell Jr, MD (105-15)

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