Lupus and Pregnancy

Pregnancy can be a risky time for all people, and these risks are higher for patients with Lupus Systemic Lupus Erythematosus (SLE, lupus). Fortunately, many of these risks can be decreased with careful planning and management. However, some of these risks persist even with our best treatments. This is a key reason that patients with lupus be evaluated by a maternal-fetal medicine (MFM, perinatalogist) obstetrician.

Checklist for a Safe Pregnancy with Lupus 

  • Lupus activity is low
  • Medications are pregnancy compatible
  • Hydroxychloroquine (HCQ) is taken throughout
  • Aspirin 81mg a day is taken
  • Antiphospholipid (APS) antibodies are checked and managed
  • Antibodies to Ro/SSA are checked and managed
  • Hypertension is controlled

Patient is referred to a maternal-fetal medicine provider (MFM)

Risks of Lupus to Pregnancy

The risks of pregnancy loss, preterm birth, and preeclampsia are increased for all patients with SLE, but are especially high for patients with certain risk factors*:

PATIENT STATUSRELATIVE RISK% Pregnancy Loss% Preterm Birth% Preeclampsia
Healthy (no rheumatic disease)Baseline~15%~10%~4%

Mild undifferentiated connective tissue disease

No Increase~15%~10%~4%
Lupus without disease activitySmall Increase~17%~20%~6%
Lupus with mild-moderate activityGreater Increase~25%~30%~10%
Lupus with controlled hypertensionGreater Increase~20%~40%~15%
Lupus with APS with treatmentGreater Increase~25%~40%~10%
Lupus with active lupus, esp. in kidneysLargest Increase~40%~60%~30%
Lupus with uncontrolled hypertensionLargest Increase~40%~65%~20%
Lupus with APS without treatmentLargest Increase~90%??

*References: Buyon 2015 2006 2022. 2022.