Lupus and pregnancy: a high-risk association?

By Ana Espino | Published on May 7, 2026 | 4 min read


Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominantly affects women of childbearing age. Pregnancy represents a major challenge in this context due to the complex interactions between the immunological, hormonal, and vascular changes inherent to gestation and disease activity.

Despite therapeutic advances, pregnancy in women with lupus remains associated with an increased risk of complications, requiring specialized and proactive management.

This systematic review, based on the analysis of 65 studies including more than 7,800 pregnancies, was conducted to explore the bidirectional relationship between lupus and pregnancy: on one hand, the impact of SLE on maternal and fetal outcomes, and on the other, the influence of pregnancy on disease activity.

Pregnancy and lupus: a complex interaction

Pregnancy induces major immunological adaptations aimed at tolerating the fetus. In patients with lupus, these adjustments are often incomplete, promoting persistent inflammation and disease exacerbation.

Hormonal changes, particularly increased levels of estrogens and prolactin, stimulate B lymphocyte activity and autoantibody production, which may worsen lupus activity. At the same time, vascular alterations and chronic inflammation contribute to placental and thromboembolic complications.

Clinically, lupus flares occur in approximately 15–40% of pregnancies, most often in moderate forms. Their frequency strongly depends on disease activity at the time of conception, highlighting the importance of careful pregnancy planning.

What are the consequences for the mother and the fetus?

Pregnancies in women with lupus are associated with a significantly increased risk of adverse pregnancy outcomes (APOs).

The most common complications include:

·    Preterm birth (the most frequent complication, >30% of cases); ·         Miscarriages and fetal loss;
· Intrauterine growth restriction (IUGR);
·  Preeclampsia, with a 2- to 3-fold increased risk;
·   Low birth weight and neonatal mortality.  

Several aggravating factors have also been clearly identified:

·  Active lupus (especially lupus nephritis);
·   Presence of antiphospholipid antibodies (aPL), associated with increased risk of thrombosis and fetal loss;
·  History of adverse pregnancy outcomes;
·  Hypertension or kidney involvement.  

Conversely, treatment with hydroxychloroquine appears to have a protective effect on pregnancy outcomes.

Specific complications: the role of autoantibodies

Autoantibodies play a central role in fetal complications.

•  Antiphospholipid antibodies promote placental thrombosis, leading to IUGR and fetal death;
•   Anti-Ro/SSA and anti-La/SSB antibodies can cross the placenta and induce neonatal lupus. 

Neonatal lupus is usually transient but may cause a severe complication: congenital heart block, which can be irreversible and may require a pacemaker.

 Can pregnancy be made safer in women with lupus?

Management is based on a key principle: anticipation and a multidisciplinary approach. Before conception, it is recommended to:

•  Achieve disease remission for at least 6 months;
•   Assess risk factors (renal involvement, autoantibodies, hypertension);
•  Adjust treatments (discontinuing teratogenic drugs).  

During pregnancy, monitoring must be close and coordinated (rheumatologist, obstetrician, nephrologist).

Treatment includes:

•  Hydroxychloroquine (HCQ): a cornerstone therapy, safe during pregnancy;
•  Corticosteroids and compatible immunosuppressants if needed;
•  Low-dose aspirin and anticoagulation in cases of antiphospholipid antibodies.

Toward personalized medicine in lupus pregnancy?

This review, recently published in Medical Sciences, highlights a significant improvement in the prognosis of lupus pregnancies, thanks to better risk stratification and optimized treatments.

However, several challenges remain:

•  Heterogeneity of studies and definitions;
•  Difficulty distinguishing lupus flares from pregnancy-related symptoms;
•   Lack of randomized clinical trials.

The future lies in:

•   Identifying predictive biomarkers;
•   Developing targeted (biologic) therapies;
•   A personalized approach tailored to each patient’s immunological profile.


Conclusion

Pregnancy in women with lupus remains a high-risk situation but is no longer contraindicated. Careful planning, well-controlled disease, and multidisciplinary management now make it possible to significantly improve maternal and fetal outcomes. “Lupus and pregnancy represent a delicate balance, requiring precision medicine to ensure the best possible prognosis,” the authors conclude.



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About the author – Ana Espino
PhD in Immunology, specialized in Virology  
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions