Clinical Question: What is the outcome of pregnancy in patients with systemic lupus erythematosus (SLE)?

Setting: Outpatient (specialty)

Study Design: Cohort (prospective)

Synopsis: This study was derived from the Hopkins Lupus Cohort, which included pregnant patients enrolled between 1987 and 2002. The authors determined the pregnancy outcomes at the time of the first postpartum visit via telephone or mailed survey. The authors did not include six elective abortions in the analysis.

Among 203 women with SLE, 267 pregnancies occurred for which they had complete follow-up. Of the total pregnancies, 229 (86 percent) were live births, 142 (53 percent) of which were full term. There were 19 miscarriages (7 percent) and 23 infants born between 20 and 28 weeks of gestation (9 percent). Approximately one half (58 percent) of women with active lupus before pregnancy had high lupus activity during pregnancy, compared with only 8 percent of women with quiescent lupus before pregnancy. Fifty-seven pregnancies occurred in women with moderate to severe SLE activity. Most of the women with increased SLE activity experienced it only during one trimester. Among the women with high SLE activity as assessed by their physicians, the outcomes were worse. Only 77 percent had live births, 26 percent of which were full term.

Bottom Line: Women with lupus who become pregnant have high rates of perinatal morbidity and mortality. The outcomes are even worse in women with severe SLE. (Level of Evidence: 1b)