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.
Read next : Between
cholesterol and systemic lupus erythematosus
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
