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Pregnancy in women with systemic lupus erythematosus

Bonnie L Bermas, MD
Nicole A Smith, MD, MPH
Section Editors
David S Pisetsky, MD, PhD
Charles J Lockwood, MD, MHCM
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age. Fertility in SLE patients does not appear to be altered by disease itself; however, a decrease in ovarian reserve can occur in women exposed to cyclophosphamide.

Pregnancy in women with SLE carries a higher maternal and fetal risk compared with pregnancy in healthy women. The prognosis for both mother and child is best when SLE has been quiescent for at least six months prior to the pregnancy. Disease flares during SLE pregnancy pose challenges with respect to distinguishing physiologic changes related to pregnancy from disease-related manifestations. Thus, a multidisciplinary approach with close medical, obstetric, and neonatal monitoring is necessary to optimize both maternal and fetal outcomes.

This topic review will discuss the major risks associated with pregnancy in SLE patients, as well as management recommendations. Issues related to menstrual function, menopause, estrogen replacement therapy, and the use of oral contraceptives in women with systemic lupus erythematosus are presented separately (see "Menstrual function, menopause, and hormone replacement therapy in women with systemic lupus erythematosus" and "Approach to contraception in women with systemic lupus erythematosus"). Issues related to pregnancy in patients with impaired renal function or with antiphospholipid syndrome (APS) are also presented elsewhere. (See "Pregnancy in women with underlying renal disease" and "Pregnancy in women with antiphospholipid syndrome" and "Neonatal lupus: Epidemiology, pathogenesis, clinical manifestations, and diagnosis".)


Ideally, disease should be quiescent for six months prior to systemic lupus erythematosus (SLE) patients attempting conception. Active SLE at the time of conception is a strong predictor of adverse maternal and obstetrical outcomes [1-3]. In spite of this risk, the majority of such pregnancies still result in live births. The following studies are illustrative:

The largest observational study, including 385 pregnant lupus patients with inactive or mild or moderate disease at conception, found 81 percent of subjects had uncomplicated pregnancies [4]. After controlling for baseline risk factors such as lupus anticoagulant, treatment for hypertension, thrombocytopenia, disease flare, or moderate disease activity at baseline, non-Hispanic white patients had an 8 percent rate of adverse pregnancy outcomes. However, the study population was limited as it excluded women with high disease activity, active lupus nephritis, uncontrolled hypertension, and diabetes.


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Literature review current through: May 2017. | This topic last updated: Apr 07, 2017.
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