SLE & Pregnancy

(2015). Maternal and foetal outcomes in pregnant systemic lupus erythematosus patients: an incident cohort from a stable referral population followed during 1990–2010. Scandinavian Journal of Rheumatology: Vol. 44, No. 5, pp. 377-384. doi: 10.3109/03009742.2015.1013982

This study looked at pregnancy outcome among Lupus patients over a 2-decade period (1990-2010), compared to otherwise healthy individuals. The numbers don’t look good:
1) 26% of lupus pregnancies did not result in livebirths, with the presence of the Antiphospholipid antibodies being associated with a 3-fold increase risk of miscarriage;
2) complication rates were 50% among mothers, 33% among foetuses;
3) SLE flared in 46%, with pre-eclampsia in 8% and HELLP in 5%;
4) intrauterine growth restriction, premature delivery and Caesarean rates were significantly higher among Lupus patients.

In largest study to date, 81% of pregnant women with lupus had no complications.

In this more recent and much larger study (largest-to-date) looking solely at Lupus patients (PROMISSE), the pregnancy outcome numbers are far better. Maternal complication rate was below 20%.
This may be attributable to better management of SLE: ensuring disease remission (preferably) before embarking on pregnancy, and very close follow-up during pregnancy.
Risk factors for poorer outcomes have been identified. Read on.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect various organs of the body. With the exception of women who have…

This is a good checklist for Lupus patients before, during and after pregnancy: the “do’s” and “don’t’s”; including what drugs to avoid, and, more importantly, what drugs to continue. The worst thing one can do is to enter into pregnancy with active disease, or to risk disease flaring during pregnancy, because vital medicines were stopped due to misinformation or misconceived notions like wanting to go “au naturale”.

Breastfeeding is known to improve the well-being of a mother and her infant, and about half of all new mothers breastfeed, but it is unknown how breastfeeding is pursued in systemic lupus erythematosus (SLE; lupus) patients. We sought to determine the rate of breastfeeding and the facto…

“Hydroxychloroquine, azathioprine, methotrexate, and prednisone have very limited transfer into breast milk and may be continued while breastfeeding.”