Pregnancy and lupus nephritis.

Area of Science:

• Nephrology
• Rheumatology
• Obstetrics

Background:

• Family planning and pregnancy present unique challenges for women with lupus nephritis.
• Factors like renal insufficiency and prior cytotoxic drug use can impact fertility.
• Certain oral contraceptives are contraindicated in active lupus nephritis or related conditions.

Purpose of the Study:

• To outline the considerations and risks associated with pregnancy in women diagnosed with lupus nephritis.
• To identify factors influencing fertility and contraindications for hormonal contraception.
• To describe the maternal and fetal outcomes and necessary surveillance during pregnancy.

Main Methods:

• Review of existing literature on lupus nephritis and pregnancy.
• Analysis of factors affecting fertility and contraceptive choices.
• Evaluation of pregnancy outcomes, including maternal flares and fetal complications.

Main Results:

• Pregnancy outlook is favorable if lupus nephritis is quiescent for 6 months, with controlled creatinine, proteinuria, and blood pressure.
• Mild systemic lupus erythematosus (SLE) flares are common, but severe renal flares are uncommon.
• Pregnancy carries a 2-3 times higher risk of fetal loss, pre-eclampsia, prematurity, and growth retardation, especially with antiphospholipid antibodies.

Conclusions:

• Pregnancy in women with lupus nephritis necessitates meticulous maternal and fetal surveillance.
• Optimizing disease control before conception significantly improves pregnancy outcomes.
• Antiphospholipid antibodies are associated with particularly poor fetal outcomes, requiring heightened vigilance.