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Updated: Apr 15, 2026
Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Disease Activity Trajectories During Pregnancy Predict Medically Indicated Complications in Women with Systemic Lupus
Meng Jiang1,2, Yanling Chang1,2, Wen Di1,2,3
1Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Abstract:
Background: Pregnancy in women with systemic lupus erythematosus (SLE) carries an increased risk of maternal and obstetric complications. Current risk assessment often relies on disease activity measured at a single time point and may not reflect dynamic changes during pregnancy. The clinical value of longitudinal disease activity trajectories remains insufficiently defined. Methods: We conducted a retrospective cohort study of 245 pregnancies in women with SLE managed at a tertiary referral center. Disease activity was assessed longitudinally and classified into three trajectories: persistent low activity, early flare with subsequent control, and uncontrolled disease activity during pregnancy. The primary outcome was a composite of clinically actionable maternal or obstetric complications prompting medical intervention. Multivariable logistic regression was performed to evaluate associations between disease activity trajectories and the primary outcome. Results: Clinically actionable pregnancy complications occurred in 41 out of 245 pregnancies (16.7%). The incidence differed significantly across disease activity trajectories, occurring in 3.9% of pregnancies with persistent low activity, 11.6% with early flare followed by control, and 63.8% with uncontrolled disease activity during pregnancy (p < 0.001). After adjustment for relevant covariates, uncontrolled disease activity remained strongly associated with the primary outcome (adjusted odds ratio 13.45, 95% confidence interval 4.01-45.08), whereas early flare with subsequent control was not associated with increased risk. Conclusions: Disease activity trajectories during pregnancy are strongly associated with clinically actionable pregnancy complications in women with SLE. Uncontrolled disease activity confers a markedly increased risk, while early disease flare followed by effective control does not. Trajectory-based assessment may improve risk stratification and support more individualized management during SLE pregnancies.
