Pregnancy outcomes in women with rheumatologic diseases and neurologic involvement

Primary neurologic involvement represents one of the most serious manifestations of systemic autoimmune diseases, yet the influence on pregnancy outcomes remains poorly characterized across disorders. To describe neurologic disease activity and maternal-fetal outcomes in pregnancies occurring after the onset of systemic autoimmune-associated neurologic involvement. A retrospective case series was conducted within the Mass General Brigham healthcare system (2010-2025), including women with systemic autoimmune disease and objectively characterized neurologic involvement who experienced pregnancy following neurologic disease onset. Neurologic disease activity across the peripartum period and associated maternal and fetal outcomes were explored. Thirteen patients with systemic lupus erythematosus (SLE; 38 pregnancies), 20 with Sjögren's disease (SJD; 45 pregnancies), and 5 with sarcoidosis (14 pregnancies) met inclusion criteria; no eligible Behçet's disease cases were identified. In SLE, central nervous system involvement occurred in 69.2%, while neurologic worsening occurred during pregnancy in 38.5% and postpartum in 23.1%. Among 25 viable SLE deliveries, hypertensive disorders of pregnancy occurred in 24.0% and preterm delivery in 20.0%. In SJD, peripheral nervous system involvement occurred in 90.0% and autonomic dysfunction in 55.0%; neurologic worsening occurred during pregnancy in 5.0% and postpartum in 30.0%. Among 33 viable SJD deliveries, preterm delivery occurred in 9.1% and hypertensive disorders of pregnancy in 6.1%. Among 5 patients with sarcoidosis, peripheral and central nervous system involvement occurred in 60.0% and 40.0%, respectively; among 9 viable deliveries, hypertensive disorders of pregnancy occurred in 33.3% and preterm delivery in 22.2%. Medication exposures were heterogeneous across diseases and reproductive stages. Peripartum women with systemic autoimmune diseases and related neurologic involvement represent a clinically heterogeneous and medically complex population. Distinct disease-specific neurologic phenotypes may influence patterns of obstetric morbidity and postpartum neurologic vulnerability, highlighting the need for prospective multicenter studies with standardized neurologic phenotyping and longitudinal postpartum follow-up.