American Board of Internal Medicine (ABIM) Certification Practice Exam

What medications are considered safe for use during pregnancies affected by systemic lupus erythematosus (SLE)?

1. Methotrexate and Cyclophosphamide

2. Hydroxychloroquine, Prednisone, and Azathioprine

3. Corticosteroids only

4. None of the above

The correct answer is: Hydroxychloroquine, Prednisone, and Azathioprine

The use of medications during pregnancy in patients with systemic lupus erythematosus (SLE) requires careful consideration due to potential risks to both the mother and the developing fetus. Hydroxychloroquine, prednisone, and azathioprine are considered safer options for managing SLE during pregnancy. Hydroxychloroquine is an antimalarial medication that is often used in managing lupus. It has been shown to reduce disease flares in pregnant women with SLE and is associated with a lower risk of birth defects. Prednisone, a corticosteroid, can also be used in pregnant patients with lupus as it can adequately control flares without significant harm to the fetus, especially when used at the lowest effective dosage. Azathioprine, an immunosuppressive medication, has been utilized during pregnancy as well, although it is generally advised to use it with caution and in selected cases. In contrast, methotrexate and cyclophosphamide are contraindicated during pregnancy due to their teratogenic effects and potential for causing fetal harm. Methotrexate is a folate antagonist that can disrupt fetal development, while cyclophosphamide carries risks of infertility and congenital anomalies. Corticosteroids, while they can be used during pregnancy,