Systemic lupus erythematosus and pregnancy

Systemic lupus erythematosus (SLE) is a multisystem autoimmune connective tissue disorder that primarily affects women of childbearing age. While it has been long recognized that pregnancies in SLE patients are high risk to both mother and fetus, pregnancy outcomes in women with SLE have significantly improved over the last four decades. However, the incidences of spontaneous abortion, stillbirth, intra-uterine growth retardation, and prematurity are increased at least two-fold compared with the normal population. Maternal renal disease, and particularly active lupus nephritis, impaired renal function, and hypertension at the time of conception are strong predictor of adverse fetal outcome. Another major contributor to adverse SLE pregnancy outcomes is antiphospholipid syndrome (APS), defined as the presence of an antiphospholipid antibody (APL) in association with clinic features of venous/arterial thrombosis or specific pregnancy complications. APS is frequently seen in association with SLE and has been linked to recurrent fetal loss. Normal renal function, controlled blood pressure, and the absence of APL/APS are predictors of favorable fetal out-comes. The risk for flare may be a function of the disease activity prior to pregnancy. Therefore, to avoid further exacerbation of lupus activity by pregnancy, planned conception in SLE patients is advisable, ideally 12-18, but not less than 6 months, after an established remission. As the care of these patients frequently crosses specialties, it should encompass consultations with nephrology and rheu-matology. Postnatal maternal monitoring by a nephrologist is indicated for optimization of hypertension and lupus nephritis treatment, without concerns for medication-related fetal adverse effects.