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 STATUS | RELATIVE 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 activity | Small Increase | ~17% | ~20% | ~6% |
| Lupus with mild-moderate activity | Greater Increase | ~25% | ~30% | ~10% |
| Lupus with controlled hypertension | Greater Increase | ~20% | ~40% | ~15% |
| Lupus with APS with treatment | Greater Increase | ~25% | ~40% | ~10% |
| Lupus with active lupus, esp. in kidneys | Largest Increase | ~40% | ~60% | ~30% |
| Lupus with uncontrolled hypertension | Largest Increase | ~40% | ~65% | ~20% |
| Lupus with APS without treatment | Largest Increase | ~90% | ? | ? |
*References: Buyon 2015 https://pubmed.ncbi.nlm.nih.gov/26098843/; Clowse 2006 https://pubmed.ncbi.nlm.nih.gov/16449114/; Lucas 2022. https://pubmed.ncbi.nlm.nih.gov/36017607/; Clowse 2022. https://pubmed.ncbi.nlm.nih.gov/35318256/
