Navigating Pregnancy with Lupus: Understanding Risks and Improving Outcomes

Systemic lupus erythematosus (SLE), an autoimmune disease, primarily affects women during childbearing years, and adverse pregnancy outcomes are known risk factors for these patients. While medical advancements have improved pregnancy outcomes and many pregnancies with SLE are successful, the condition still presents unique challenges that require careful management.

Hormone changes during pregnancy can trigger lupus flares, increasing the risk of complications for both mother and baby. By understanding these risks, we can implement proactive measures to optimize care, reduce complications, and improve outcomes. Additionally, recognizing the potential impact of undiagnosed autoimmune conditions on pregnancy complications may help identify at-risk patients earlier.

Understanding Risk Factors Among Pregnant Patients with SLE

A recent comprehensive analysis reviewed 72 research articles that reported preconception predictors across 10,355 pregnancies in 8,065 women with SLE. This extensive review provided valuable insights into key risk factors that may affect pregnancy outcomes in women with SLE.

Women with a history of lupus-related kidney disease (lupus nephritis) experienced:

• Lower chance of live birth (by 38 percent)
• Higher risk of preterm birth (2x higher)
• Higher risk of preeclampsia (3.1x higher)

Women with chronic high blood pressure (hypertension) faced a greater risk of:

• Lupus flare-ups (2.5x higher)
• Preterm birth (2.65x higher)
• Preeclampsia (5.86x higher)

Active lupus at conception or before pregnancy increased the risk of:

• Preterm birth (2.91x higher)
• Preeclampsia (2.32x higher)

And secondary antiphospholipid syndrome was linked to:

• Lower chance of live birth (by 60%)
• Higher risk of pregnancy loss after 20 weeks (2.77x higher)
• Greater risk of preterm birth (1.65x higher)

Overall, these findings highlight the importance of medical monitoring for patients with SLE who are pregnant. They also highlight the importance of raising awareness about autoimmune diseases in cases where pregnancy complications can occur without a known diagnosis and with other symptoms.

For patients with SLE who are considering pregnancy, preconception counseling can be important for understanding potential risks, setting patient expectations, and ensuring appropriate medical support from the beginning. By taking a proactive approach, we can work together with patients to improve pregnancy outcomes and overall maternal health.

References

Wind, M., Fierro, J. J., Bloemenkamp, K. W. M., de Leeuw, K., Lely, A. T., Limper, M.,…Kooiman, J. (2024). Pregnancy outcome predictors in systemic lupus erythematosus: a systematic review and meta-analysis. Lancet Rheumatol, 6(10), e667-e683. https://doi.org/10.1016/S2665-9913(24)00160-7