Systemic lupus erythematosus and pregnancy

Area of Science:

• Rheumatology
• Nephrology
• Obstetrics

Background:

• Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease primarily affecting women of childbearing age.
• Pregnancies in SLE patients are considered high-risk for both mother and fetus, despite significant improvements in outcomes over recent decades.
• Adverse pregnancy outcomes like spontaneous abortion, stillbirth, intrauterine growth retardation, and prematurity occur at least twice as frequently in SLE patients compared to the general population.

Purpose of the Study:

• To review and summarize the current understanding of pregnancy outcomes in women with SLE.
• To identify key predictors of adverse fetal outcomes in SLE pregnancies.
• To provide recommendations for optimizing pregnancy management in SLE patients.

Main Methods:

• Review of existing literature on SLE and pregnancy.
• Analysis of factors influencing maternal and fetal outcomes.
• Synthesis of clinical recommendations for patient management.

Main Results:

• Maternal renal disease, active lupus nephritis, impaired renal function, and hypertension at conception are strong predictors of adverse fetal outcomes.
• Antiphospholipid syndrome (APS), often associated with SLE, significantly contributes to adverse outcomes, including recurrent fetal loss.
• Favorable fetal outcomes are associated with normal renal function, controlled blood pressure, and the absence of antiphospholipid antibodies (APL)/APS.

Conclusions:

• Planned conception in SLE patients is advisable, ideally 6-18 months after achieving remission, to minimize disease flares.
• Optimal management requires multidisciplinary collaboration, including nephrology and rheumatology consultations.
• Postnatal monitoring by a nephrologist is crucial for managing hypertension and lupus nephritis, with consideration for medication safety for the fetus.