Risk factors for adverse pregnancy outcomes in systemic lupus erythematosus: a meta-analysis and systemic review

Systemic lupus erythematosus (SLE) is a prominent autoimmune disease highly linked to adverse pregnancy outcomes (APOs). Previous research on the risk factors for APOs in SLE pregnancies has been limited by regional constraints or inadequate sample sizes. Comprehensive systematic reviews on this topic remain scarce. To address these research gaps, we conducted a rigorous meta-analysis and systematic review to elucidate the risk factors for APOs in SLE pregnancies.

PubMed, Embase, Web of Science, and the Cochrane Library systematically searched for articles on risk factors for APOs in SLE pregnancy from initiation to March 25, 2025. Pooled odds ratios (ORs) were calculated using fixed-effect or random-effects models based on heterogeneity (I²). Egger's test was used to assess publication bias.

A total of 43 studies were reviewed. Patients with hypertension, lupus nephritis (LN), high disease activity, low complements, and antiphospholipid syndrome (APS)/positive antiphospholipid antibodies (aPL) were identified as having a higher risk for adverse pregnancy outcomes (APOs). Risk factors for preterm birth included LN, hypertension, disease flares, high disease activity, and APS/aPL. Risk factors for pregnancy loss included APS/aPL, low complements, disease flares, LN, hypertension, thrombocytopenia, and high disease activity. LN was also associated with an increased risk of intrauterine growth restriction and low birth weight.

This study identified risk factors for APOs in SLE pregnancies. These findings may support early identification of high-risk patients and guide timely interventions to improve maternal and fetal outcomes.