Management of pregnancy in systemic lupus erythematosus


Systemic lupus erythematosus (SLE) is an autoantibody-mediated systemic autoimmune disease, predominantly affecting young females. Pregnancy is increasingly common in the setting of SLE, as survival and quality of life of patients improve. Although live births can be achieved in the most cases, pregnancy in patients with SLE remains a high-risk condition. Maternal and fetal mortality and morbidity are considerably increased, compared with the general population. Aberrations in pregnancy-related maternal immune adaptations are likely contributors. Active maternal disease, renal involvement, specific autoantibody subsets and advanced organ damage are predictors of poor outcome. Therapeutic options are limited during pregnancy as maternal benefit has to be weighed against fetal risk. Prevention of preterm birth and refractory pregnancy loss, as well as management of established neonatal heart block remain unmet needs. Further research should address these important issues that affect young patients with SLE and their babies.

Key Points

  • Pregnancy in the setting of systemic lupus erythematosus (SLE) is increasingly common

  • Physiological immune adaptations of pregnancy are altered in women with SLE

  • Successful pregnancies are possible in most young women with SLE, but active disease at conception is associated with poor outcomes

  • Preconception assessment is necessary to risk-stratify patients

  • Disease flares, pre-eclampsia, fetal loss, prematurity, intra-uterine growth restriction and neonatal lupus syndromes remain the main issues

  • Treatment of neonatal heart block and refractory pregnancy loss, in the presence of antiphospholipid antibodies, remain far from optimal

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Figure 1: Proposed schema for pregnancy planning in women with systemic lupus erythematosus.


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Both authors researched the data for the article, made substantial contribution to discussion of content, writing and editing of the manuscript before submission.

Correspondence to Michelle Petri.

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Lateef, A., Petri, M. Management of pregnancy in systemic lupus erythematosus. Nat Rev Rheumatol 8, 710–718 (2012).

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