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The aim of this study was to examine the pregnancy outcomes in patients with systemic lupus erythematosus (SLE) and the effect of SLE flare and treatment on pregnancy outcomes. We performed a retrospective evaluation of all pregnancies occurring in patients with SLE during the 27-year period from 1980 to 2006. Of the 319 women with SLE planning pregnancy after SLE onset, 176 (55.2%) conceived resulting in 396 pregnancies. Live births were significantly lower in proportion (70.2% vs. 85.7%) and more likely to end in fetal deaths (29.7% vs. 14.2%) and preterm births (26.7% vs. 5.8 %) in pregnancies occurring after SLE onset than in pregnancies occurring before SLE onset (p < 0.0001). With respect to different disease manifestations, we found that fetal loss was significantly higher in patients with antiphospholipid (aPL) antibodies than without (p < 0.001). Preterm deliveries were significantly more frequent in patients with lupus nephritis, anti-Ro/SSA antibodies, hypertension, history of intravenous cyclophosphamide treatment and aPL than those without these features (p < 0.05). Neonates with intrauterine growth retardation (IUGR) neonates were more common in hypertensive and Raynaud’s-positive pregnancies (p < 0.05). SLE flares occurred in 30.8% pregnancies. There was increased risk of fetal loss, preterm births and IUGR in pregnancies with SLE exacerbations than without (p < 0.05). Prednisolone was found to improve the rate of live births, although it was also a predictor of prematurity. The predictors of pregnancy loss were lupus nephritis (odds ratio (OR) 7.3), aPL (OR 3.9), and SLE flares in pregnancy (OR 1.9). There was higher risk of preterm deliveries in patients with lupus nephritis (OR 18.9), anti-Ro antibodies (OR 13.9), hypertension (OR 15.7) and SLE flares (OR 2.5). IUGR was found to be associated with hypertension (OR 37.7), Raynaud’s (OR 12.3), and SLE flares (OR 4.2). In conclusion, pregnancies in SLE patients with active lupus nephritis, anti-Ro/SSA antibodies, aPL, hypertension, Raynaud’s phenomenon, active disease at conception and SLE exacerbations are at a higher risk of adverse pregnancy outcomes. It is important to carefully plan pregnancy, and experienced rheumatologists and obstetricians should monitor SLE patients in pregnancy and postpartum.

Our objective was to study the demographic, clinical, laboratory features, therapy, and outcome of systemic lupus erythematosus (SLE) patients. In this retrospective study, which covered a 27-year period (1980–2006), 624 SLE patients referring to King Khalid University hospital, Riyadh were included. There were 566 females and 58 males (9.8:1) with a mean age of 34.3 (range 8–71) years and mean age at disease onset of 25.3 years (range 0.08–67). The mean disease duration was 9.3 years (range 0.3–30). The most common disease manifestations were hematological abnormalities (82.7%), arthritis (80.4%), and mucocutaneous symptoms (64.3%). The prevalence of malar rash was 47.9%, discoid rash 17.6%, photosensitivity 30.6%, oral ulcers 39.1%, serositis 27.4%, nephritis 47.9%, and neuropsychiatric manifestations 27.6%. Lymphopenia (40.3%), anti-Ro (53.1%), anti-La (26.6%), anti-Sm (41.6%), anticardiolipin IgG (49.7%), and IgM (33.5%) antibodies were highly prevalent. Antinuclear antibodies were detected in 99.7% and anti-DNA in 80.1% patients. Low C3 and C4 were observed in 45.4% and 42.2%, respectively. Therapy included oral steroids (96.2%), IV cyclophosphamide (34.1%) and azathioprine (32.1%) along with other drugs. Long-term remission was achieved in 82.4%, disease was active in 2.6%, renal failure occurred in 4.3% requiring dialysis, 6.7% lost follow up and 4.0% patients died. Infections (48%) and active SLE (36%) were the common causes of death. The 5- and 10-year patient survival rate was 98% and 97%, respectively. This study suggests that, in our patients, SLE manifests with features similar to SLE patients from other Arab countries and Caucasia. In comparison to Caucasians, higher prevalence of anti-Ro antibodies is observed in our study, in some Middle-Eastern and Asian countries; this may likely be due to inter-ethnic variation owing to genetic differences. Our 5-year patient survival rate was similar to that of western countries, while 10-year survival rate was better than that of most places.