Systemic lupus erythematosus in pregnancy - intricate, but wieldy

Ritin Mohindra, Sheeba Marwah


Systemic Lupus Erythematosus (SLE) predominantly afflicts young women in reproductive age. In this context, it is only rational that pregnancy and its outcome becomes an imperative concern for the lupus patients and their health care providers. Queries regarding the risk of disease flares during pregnancy, chance of fetal loss, and the safety of various drugs are often raised. However the present day availability of effective treatment regimens has meant that many patients achieve protracted remissions and better disease control. Indeed, a high proportion of lupus patients, with professional care, can thus look forward to a successful pregnancy.1 This article reviews the contemporary concepts regarding SLE and pregnancy, especially regarding the fertility rate, optimal timing of conception, risk of disease flares during lupus pregnancy, pregnancy course, fetal outcome, safety of various drugs used for disease control during pregnancy and lactation, and contraceptive advice.


Systemic lupus erythematosus, Lupus, Pregnancy, Fetal outcome, Maternal outcome

Full Text:



Lockshin MD, Reinitz E, Druzin ML, Murrman M, Estes D. Lupus pregnancy. Case-control prospective study demonstrating absence of lupus exacerbation during or after pregnancy. Am J Med. 1984;77:893-8.

Urowitz MB, Gladman DD, Farewell VT, Stewart J, McDonald J. Lupus and pregnancy studies. Arthritis Rheum. 1993;36:1392-7.

Petri M, Howard D, Repke J. Frequency of lupus flare in pregnancy. The Hopkins Lupus Pregnancy Center experience. Arthritis Rheum. 1991;34:1538-45.

Ruiz-Irastorza G, Lima F, Alves J, Khamashta MA, Simpson J, Hughes GR, et al. Increased rate of lupus flare during pregnancy and the puerperium: a prospective study of 78 pregnancies. Br J Rheumatol. 1996;35:133-8.

Mintz G, Niz J, Gutierrez G, Garcia-Alonso A, Karchmer S. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach. J Rheumatol 1986;13:732-9.

Wong KL, Chan FY, Lee CP. Outcome of pregnancy in patients with systemic lupus erythematosus. A prospective study. Arch Intern Med. 1991;151:269-73.

McNeil HP, Chesterman CN, Krilis SA. Immunology and clinical importance of antiphospholipid antibodies. Adv Immunol. 1991;49:193.

Buyon JP, Kalunian KC, Ramsey-Goldman R, Petri MA, Lockskin MD, Ruiz-Irastorza G, et al. Assessing disease activity in SLE patients during pregnancy. Lupus. 1999;8:677-84.

Khamashta MA, Hughes GRV. Pregnancy in systemic lupus erythematosus. Curr Opin Rheumatol. 1996;8:424-9.

Petri M. Systemic lupus erythematosus: women’s health issues. Bull Rheum Dis. 2000;49:1-3.

Mok CC, Wong RWS. Pregnancy in systemic lupus erythematosus. Postgrad Med J. 2001;77:157-65.

Buyon JP, Cronstein BN, Morris M, Tanner M, Weissmann G. Serum complement values (C3 and C4) to differentiate between systemic lupus activity and preeclampsia. Am J Med. 1986;21:194-200.

Petri M. Pregnancy in SLE. Ballieres Clin Rheumatol. 1998;12:449-76.

Martinez-Rueda JO, Arce-Stalinas CA, Kraus A, Alcocer-Varela J, Alarcón-Segovia D. Factors associated with fetal losses in severe systemic lupus erythematosus. Lupus. 1996;5:113-9.

Ruyon JP, Hiebert R, Copel J, Craft J, Friedman D, Katholi M, et al. Autoimmune associated congenital heart block, demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J Am Coll Cardiol. 1998;31:1658-66.

Meng C, Lockskin M. Pregnancy in lupus. Curr Opin Rheumatol. 1999;11:348-51.

Buyon JP, Clancy RM. Neonatal lupus: review of proposed pathogenesis and clinical data from the US-based Research Registry for Neonatal Lupus. Autoimmunity. 2003;36:41-50.

Lockshin MD, Sammaritano LR, Schwartzman S. Lupus pregnancy. In: Lahita RG, eds. Systemic Lupus Erythematosus. 3rd ed. New York: Academic Press; 1999: 507-536.

Ramsey-Goldman R, Schilling E. Immunosuppressive drug use during pregnancy. Rheum Dis Clin North Am. 1997;23:149-67.

Turner G, Collins E. Fetal effects of regular salicylate ingestion in pregnancy. Lancet. 1975;ii:338-9.

Jick H, Holmes LB, Hunter JR, Madsen S, Stergachis A. First-trimester drug use and congenital disorders. JAMA. 1981;246:343-6.

Reber PM. Prolactin and immunomodulation. Am J Med. 1993;295:637-44.

Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics. 1994;93:137-50.

Lockshin MD, Sammaritano LR. Lupus pregnancy. Autoimmunity. 2003;36:33.

Andrade RM, McGwin G Jr, Alarcón GS, Sanchez ML, Bertoli AM, Fernández M, et al. Predictors of post-partum damage accrual in systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (XXXVIII). Rheumatology (Oxford). 2006;45:1380-4.