What factors do you consider when advising a patient with lupus nephritis on the safety of becoming pregnant?

I agree with Dr. @Dr. First Last's excellent suggestions (with just one exception!). I don't increase prednisone prophylactively for lupus pregnancy - I would only add or increase steroid if there is a flare. The risks of steroid in pregnancy impact both maternal and pregnancy outcomes, so we try to...

My approach, make sure you are in remission (tough to define, I agree) for at least 6 months.

• Get a high-risk OB.
• Take ASA for preeclampsia prophylaxis.
• Bump up your immunosuppression, perhaps add a bit of prednisone (15-20?).
• Get off MMF but change it to azathioprine.
• Consider a CNI if proteinuria...

The question doesn't say whether:

❓The patient has active lupus nephritis (LN) with continued proteinuria urine: protein creatinine ratio > 800 mg/mg (UPCR > 800), and her lupus nephritis drugs are still being altered in the attempt to control her disease

❓OR If the patient had recent lupus nephriti...