Systemic lupus erythematosus in pregnancy.

Women with SLE are at risk for developing a greater number of complications during pregnancy and have a lesser chance for a successful outcome for the conceptus than do normal healthy gravidas. These complications probably result, at least in part, from the action of estrogens to stimulate the underlying immunologic disorder of SLE. In addition, women with hypertension, renal functional abnormalities, or other complications resulting from SLE are likely to share the same risk factors as women with these afflictions due to non-SLE disorders. Recent studies, however, show that the incidence of clinical flares during pregnancy and diminished fetal survival are not as exaggerated as were described in earlier reports and small case series, probably owing to more adequate suppression of SLE activity with glucocorticoids and immunosuppressive drugs, and to improvements in fetal monitoring and maternal care. Women in complete clinical remission, regardless of previous manifestations of SLE, appeared to have the best outlook for uncomplicated pregnancies and the highest incidence of fetal survival. In our judgment, gravidas with established SLE should be managed in a perinatal program with an expertise available for careful systematic fetal monitoring; ready access to consultants in nephrology, rheumatology, and other relevant disciplines; and inpatient facilities for complicated gestations. In addition, all women with SLE should be screened for anti-Ro (SS-A) antibodies in order to identify fetuses at risk for cardiac conduction defects. Women with a history of recurrent in utero fetal deaths or spontaneous abortions should be screened for LE-anticoagulant, even in the absence of clinical signs of SLE.