Systemic lupus erythematosus and pregnancy: a comprehensive clinical review of maternal, fetal, and treatment considerations.

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation, predominantly affecting women of reproductive age. Consequently, its impact on pregnancy outcomes represents a critical clinical concern. Advances in disease monitoring and management have reduced pregnancy-related complications; however, risks remain higher than in the general population. Adverse outcomes, including fetal loss, preterm delivery, preeclampsia, thrombotic events, and low birth weight, are particularly common in patients with lupus nephritis. Placental insufficiency and immune-mediated inflammatory mechanisms are thought to contribute to these complications. Pregnancy may also precipitate disease reactivation, although the timing and frequency of flares are variable. Higher disease activity is consistently associated with poorer outcomes, yet prediction of flares or adverse events remains challenging. In addition, certain SLE therapies pose teratogenic risks, underscoring the importance of individualized treatment planning. Optimal outcomes are most likely when conception occurs during a period of disease quiescence, with close multidisciplinary monitoring and the use of pregnancy-compatible therapies to maintain disease control.